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

Abstract

Lemmel syndrome is a rare clinical entity characterized by the presence of a periampullary duodenal diverticulum resulting in compression and dilatation of the pancreatic and common bile ducts, accompanied by obstructive jaundice. Gastric outlet obstruction is not a known complication of this syndrome, and there are no standardized approaches to its treatment. We present the first case of Lemmel syndrome presenting as gastric outlet obstruction and provide the results of a systematic literature review.

Periampullary diverticulitis (Lemmel's syndrome) misdiagnosed as pancreatic head tumor: A report of two cases

“…In the literature, contrast-enhanced CT of the abdomen and pelvis revealed a 2.7 × 3.7 × 5.2 cm complex lesion of the pancreatic head containing air and debris, adjacent to the D2 and D3 duodenum with dilatation of the common bile duct (1 cm). There are no deaths from Lemmel's syndrome in the literature [3] . The size of the diverticulum was 30 × 25 × 20 mm on the first case, 28 × 18 × 10 mm on the second case.…”

Surgical management of a Lemmel syndrome

“…This may result in progressive jaundice 2,3 . The diagnosis is challenging as it occurs in 5% of cases 4 . Surgery is indicated in symptomatic patients.…”

“…Indeed, many modalities are used such as abdominal Ultrasound (US), endoscopy, magnetic resonance cholangiopancreatography (MRCP) and CT‐scan 6 . MRCP is a more specific tool than abdominal US and CT‐scan 4,7,8 . Endoscopy with side‐viewing duodenoscope is the main tool to visualize the lesion and to conduct an immediate endoscopic intervention.…”

“…2,3 The diagnosis is challenging as it occurs in 5% of cases. 4 Surgery is indicated in symptomatic patients.It was a 52-year-old woman with a surgical history of colic resection through midline incision at a youthful age. She complained of vague pains in the right hypochondrium, which evolving for 1 year.…”

“…6 MRCP is a more specific tool than abdominal US and CT-scan. 4,7,8 Endoscopy with side-viewing duodenoscope is the main tool to visualize the lesion and to conduct an immediate endoscopic intervention. Surgery remains the main diagnostic and therapeutic tool.…”