Lemmel's Syndrome: Obstructive Jaundice Secondary to a Duodenal Diverticulum

Agúndez, María Carmona; López-Guerra, Diego; Pérez, Juana Fernández; Fernández, Gerardo Blanco

doi:10.1016/j.cireng.2017.02.004

Cited by 7 publications

(7 citation statements)

References 7 publications

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“…Lemmel's syndrome defined as hepatocholangiopancreatic disease leading to obstructive jaundice occurring in the absence of choledocholithiasis is another potential complication [6].…”

Section: Discussionmentioning

confidence: 99%

“…Most cases of PAD are asymptomatic and diagnosed incidentally during endoscopies, but a wide range of complications occur in 5% of the cases, such as bleeding, perforation, diverticulitis, pancreatitis, choledocholithiasis, cholangitis, and jaundice [ 5 ]. Lemmel's syndrome defined as hepatocholangiopancreatic disease leading to obstructive jaundice occurring in the absence of choledocholithiasis is another potential complication [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Lemmel's Syndrome: A Rare Complication of Periampullary Diverticula

Battah¹,

Farouji²,

Luke³

et al. 2023

Cureus

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Periampullary diverticula are outpouches in the mucosa in the duodenum surrounding the ampulla of Vater. Most cases of periampullary diverticuli are asymptomatic, but complications can arise, increasing a patient's mortality. Diagnosis of periampullary diverticuli is often incidental during endoscopy or imaging studies for abdominal pain. When a patient with periampullary diverticuli is symptomatic, imaging modalities such as CT scan and MRI can help make the diagnosis, but a side-viewing endoscope provides direct visualization of the diverticuli and also allows for the potential treatment of the disease. Lemmel's syndrome is a complication of periampullary diverticuli where the diverticuli causes mechanical obstruction of the bile duct leading to obstructive jaundice without choledocholithiasis. These patients are at risk for further complications such as sepsis and perforation. Early diagnosis and treatment of these patients can help to prevent further complications from arising. We are presenting a case of Lemmel's syndrome with obstructive jaundice from a periampullary diverticuli, further complicated by cholangitis without dilation of the biliary tree.

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“…Lemmel's syndrome defined as hepatocholangiopancreatic disease leading to obstructive jaundice occurring in the absence of choledocholithiasis is another potential complication [6].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lemmel's Syndrome: A Rare Complication of Periampullary Diverticula

Battah¹,

Farouji²,

Luke³

et al. 2023

Cureus

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“…En general, la mayoría de los pacientes cursan no solo con ictericia a expensas de bilirrubina directa, población general y su prevalencia incrementa con la edad. En México no existe registro epidemiológico de incidencia de divertículos duodenales y menos de este síndrome 4 .…”

Section: Discussionunclassified

Síndrome de Lemmel: ictericia obstructiva secundaria a divertículo duodenal yuxtapapilar. Reporte de un caso

Ramírez-Guerrero¹,

Peñaloza-Posada²

2020

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El síndrome de Lemmel es una entidad poco frecuente que se caracteriza por la presencia de ictericia obstructiva secundaria a la presencia de un divertículo duodenal periampular. Los periampulares son los más comunes, se presentan en un 75%; de estos, los que se localizan a 2-3 cm del ámpula de Vater se conocen como divertículos yuxtapapilares y la mayoría son extraluminales y adquiridos. Actualmente el diagnóstico se realiza utilizando colangiopancreatografía retrógrada endoscópica o ultrasonografía endoscópica, ya que con ambas se logra confirmar el diagnóstico. La esfinterotomía endoscópica y colocación de prótesis biliar es el tratamiento de elección en caso de complicación biliar o pancreática. Reportamos el caso de una paciente de 67 años con síndrome de Lemmel.

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“…Surgical option may be necessary in case of complicated billiary obstruction or pancreatitis, but the procedure is difficult and has high mortality 4. Symptomatic patients can also be successfully managed endoscopically through sphincterotomy or endoscopic papillary balloon dilatation 1 7. Despite being a minimal-invasive procedure, complications, such as delayed perforation of the diverticulum or stent obstruction, can occur 4.…”

Section: Discussionmentioning

confidence: 99%

“…In relatively asymptomatic patients, a conservative treatment is recommended 8. However, it can recur and even progress to stenosis of the bile duct, leading to subsequent episodes of obstructive jaundice or even cholangiocarcinoma, therefore the patient should be kept on regular observation 7…”

Section: Discussionmentioning

confidence: 99%

A rare cause of abdominal pain with fever

Oliveira¹,

Correia

Cunha

et al. 2019

BMJ Case Rep

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An 89-year-old man presented to the emergency department with a 1-month history of upper right quadrant pain, worsened in the last 3 days and accompanied by fever and chills. On physical examination, he had scleral icterus and right upper quadrant tenderness. Laboratory findings showed hyperbilirubinemia, elevated liver enzymes and C reactive protein. The patient was admitted, suspecting of an acute cholangitis and started on antibiotics. An upper gastrointestinal endoscopy revealed the presence of a juxtapapillary diverticulum in the second portion of the duodenum, which was confirmed by a magnetic resonance cholangiopancreatography, along with upstream biliary tract ectasia. The imaging findings allowed us to diagnose a Lemmel’s syndrome. Due to potential surgical risk, we decided for a conservative approach. The patient had a favourable course and was discharged home.

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Lemmel's Syndrome: Obstructive Jaundice Secondary to a Duodenal Diverticulum

Cited by 7 publications

References 7 publications

Lemmel's Syndrome: A Rare Complication of Periampullary Diverticula

Lemmel's Syndrome: A Rare Complication of Periampullary Diverticula

Síndrome de Lemmel: ictericia obstructiva secundaria a divertículo duodenal yuxtapapilar. Reporte de un caso

A rare cause of abdominal pain with fever

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