An unusual cause of obstructive jaundice: Lemmel’s syndrome

Abstract

Lemmel’s syndrome is a rare and misdiagnosed cause of obstructive jaundice. The cause of the obstacle is a duodenal diverticulum located at the periampullary generating a compression effect on the common bile duct with secondary dilation of the extra- and intra-hepatic bile ducts. Late diagnosis of this entity is common and may lead to unnecessary further investigations and therapeutic delay. There are only few case reports of this rare condition. We report a case of 77-year-old female presenting with obstructive jaundice due to Lemmel’s syndrome. The diagnosis was made on a set of clinical, biological and radiological arguments with good improvement after medical treatment.

Diagnosis and Management of Lemmel Syndrome: An Unusual Presentation and Literature Review

“…In one case, CT imaging alone was sufficient to make the diagnosis, appearing as an outpouching of the intestinal wall containing air, an air-fluid level, or debris [5]. Unfortunately, abdominal CT exams lack specificity, and a duodenal diverticula may be falsely interpreted as a possible pancreatic neoplasm or pseudocyst, as was the case for our patient [3, 11]. Thus, a suspected case of Lemmel syndrome seen on CT scan may require a more definitive study such as MRCP or endoscopy.…”

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

“…Se han publicado casos de presentación inusual, como el de un paciente que sufrió un trauma cerrado de abdomen con el desarrollo posterior de síndrome de Lemmel 13 , o el de dos pacientes con antecedente de gastrectomía subtotal Billroth 14,15 , en quienes se consideró que el asa duodenal ciega pudo causar un aumento de la presión, favoreciendo la formación de divertículos, el acumulo de detritos dentro de él, y la formación de bezoares o cálculos que causaron el síndrome de Lemmel. Los exámenes de laboratorio son de gran importancia, encontrando un patrón colestásico en el perfil hepático, que no es específico para el síndrome de Lemmel. Las imágenes diagnósticas son de mucha utilidad para establecer el diagnóstico, aunque también presentan limitaciones, como la ecografía que en los casos revisados no logró establecer la presencia del síndrome, siendo informada como normal o solamente con dilatación de la vía biliar 16 .…”

A Rare Presentation of Duodenal Diverticulum Causing Obstructive Jaundice: Lemmel's Syndrome

“…Duodenal diverticula (DD) are referred to as periampullary, peripapillary, or paravaterian diverticula (PAD) when they develop within 2-3 cm of the ampulla of Vater [ 5 ]. It can be divided into three categories depending on where the papilla is in relation to the diverticulum.…”

“…Periampullary diverticula (PAD) can be explained as extraluminal outpouchings of the duodenum that originate within 2-3cm from the ampulla of Vater [ 4 ]. Such outpouchings are also known as peripapillary or paravaterian diverticula, in addition to being called PAD [ 5 ]. The incidence of PAD ranges from 1% to 27% [ 6 ].…”