A case of a duodenal diverticulum causing obstructive jaundice � Lemmel`s syndrome

Bakula, Branko; Romić, Ivan; Sever, Marko; Halle, Željka Belošić

doi:10.17235/reed.2020.7516/2020

Cited by 7 publications

(8 citation statements)

References 3 publications

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“…La segunda opción de manejo es la quirúrgica 5,29 , mediante el empleo de diversas técnicas como la inversión del divertículo, la diverticulectomía simple o asociada a reconstrucción con anastomosis del colédoco al duodeno o al yeyuno o incluso la pancreatoduodenectomía 30 . No se encontraron descripciones de manejo laparoscópico, aunque Aguirre y colaboradores 31 reportan la realización de anastomosis del colédoco al duodeno de forma laparoscópica para el manejo de las coledocolitiasis complejas, técnica que podría ser desarrollada para el tratamiento de los pacientes con síndrome de Lemmel. El paciente tratado por los autores de esta revisión e incluido en el análisis fue intervenido de forma laparoscópica.…”

Section: Discussionunclassified

Síndrome biliar obstructivo no litiásico o de Lemmel ¿Es tan infrecuente como parece?

Ceballos¹,

Hoyos-Yepes²,

Felipe³

et al. 2023

Rev Colomb Cir

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Introducción. Aproximadamente el 5 % de los divertículos duodenales pueden causar síntomas y el 1 % presentar complicaciones, siendo la colangitis la más frecuente. El síndrome de Lemmel corresponde a un tipo de ictericia obstructiva intermitente, asociado a la presencia de divertículos periampulares y disfunción del esfínter de Oddi, sin presencia de coledocolitiasis. Método. Se realizó una revisión sistemática de la literatura en Pubmed, Google Académico y ProQuest, con los términos: síndrome de Lemmel, divertículo duodenal sintomático e ictericia obstructiva intermitente. Resultados. Se encontraron 38 casos, siendo España el país con mayor número, seguido de México, Japón y Colombia. No hay diferencias de distribución con respecto al género. El tratamiento más frecuentemente empleado fue la colangio pancreatografia retrógrada endoscópica. Conclusión. El síndrome de Lemmel es poco frecuente, sin un cuadro clínico especifico, con un incremento en los casos informados en los últimos años, posiblemente debido a la mejor disponibilidad de métodos diagnósticos. Es más frecuente en pacientes en la octava década de la vida y su tratamiento generalmente es endoscópico.

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Section: Discussionunclassified

Síndrome biliar obstructivo no litiásico o de Lemmel ¿Es tan infrecuente como parece?

Ceballos¹,

Hoyos-Yepes²,

Felipe³

et al. 2023

Rev Colomb Cir

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“…Lemmel syndrome was first described in 1934 by Lemmel, 1 as an obstructive jaundice in the absence of gallstones or neoplasm due to a periampullary duodenal diverticulum (PAD). 2 PAD is an extraluminal diverticulum of the duodenal wall located within 2 to 3 cm to the ampulla of Vater. 3 Its physiopathology isn't certain and specific, but reported mechanisms include 3 mains causes, all due to the proximity of the diverticulum to the ampulla, either causing direct external compression of the common bile duct/ampulla leading to obstruction; or causing a dysfunction of the sphincter of Oddi; or causing direct irritation of the ampulla leading to its chronic inflammation and eventually fibrosis of the papilla.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An Unusual Cause of Biliary Tract Obstruction: Lemmel Syndrome

Aourarh

Tamzaourte

Benhamdane

et al. 2021

Clin Med Insights Case Rep

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Background: Lemmel syndrome is a rare and misdiagnosed etiology of obstructive jaundice due to a periampullary duodenal diverticulum causing a mechanical obstruction of the common bile duct. It represents an obstructive jaundice with the absence of choledocholithiasis or pancreaticobiliary tumors. It is an underreported entity due to the absence of specific pathognomonic signs. Case presentation: A 77-year-old-woman admitted for sepsis, due to an ascending cholangitis, underwent a MRCP and a gastroduodenoscopy revealing Lemmel’s syndrome. Due to failure of ERCP, the patient underwent surgical derivation. Conclusion: Lemmel syndrome represents an uncommon diagnosis of obstructive jaundice, that shouldn’t be neglected if no other organic cause is detected. It is usually asymptomatic, however some patients can develop symptoms and complications such as cholangitis, as is the case of our patient. Imaging allows diagnosis, with MRCP as the modality of choice to confirm diagnosis. Endoscopy is the first line treatment.

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“…Although it can be a sign of relatively nonlethal conditions such as Dubin Johnson syndrome, choledocholithiasis, red blood cell disorders, and drug-induced liver injury [2][3][4], it can also be a sign of more grievous diseases such as advanced pancreatic cancer, cholangiocarcinoma, biliary atresia, hepatocellular carcinoma, and liver metastases [5][6][7][8]. Jaundice can even be a sign of diseases such as tuberculosis lymphadenitis, autoimmune pancreatitis, cholangiohydatidosis, duodenal diverticulum (i.e., Lemmel's syndrome), duodenal ulcer, fascioliasis (i.e., parasitic disease caused by Fasciola hepatica), and coronavirus disease 2019 [9][10][11][12][13][14][15]. Moreover, obstructive jaundice can even cause endotoxemia because of intestinal barrier failure [16].…”

Section: Introductionmentioning

confidence: 99%

Obstructive Jaundice

Kim

2022

Soonchunhyang Med Sci

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Jaundice is a medical condition in which the skin or sclera of the eyes becomes yellow, and elevation of bilirubin production or obstruction of bile excretion can cause jaundice while disrupting the balance between bilirubin production and bile excretion. Jaundice is a very visual clinical sign that both patients and physicians can easily recognize. It warrants further investigation regarding the cause of jaundice because jaundice is always a pathological sign regardless of its seriousness. Clinical manifestations of obstructive jaundice can be understood in terms of bile formation and secretion, and the anatomy of the biliary tree. Obstruction of a critical part of the biliary tree such as the common bile duct can cause jaundice, and investigating the etiology of jaundice is the first step of managing this condition. Choledocholithiasis, pancreatic ductal adenocarcinoma, cholangiocarcinoma, and biliary atresia are some of the common medical conditions that cause obstructive jaundice. Whenever jaundice is observed by a physician, early diagnosis and prompt treatment should be performed as early as possible for better outcomes.

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A case of a duodenal diverticulum causing obstructive jaundice � Lemmel`s syndrome

Cited by 7 publications

References 3 publications

Síndrome biliar obstructivo no litiásico o de Lemmel ¿Es tan infrecuente como parece?

Síndrome biliar obstructivo no litiásico o de Lemmel ¿Es tan infrecuente como parece?

An Unusual Cause of Biliary Tract Obstruction: Lemmel Syndrome

Obstructive Jaundice

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