A rare pancreaticobiliary complication of duodenal diverticula is Lemmel syndrome. Lemmel syndrome is defined as an obstructive jaundice. ABSTRACT. In Lemmel was the first to report the presence of juxtapapillary diverticula and hepatocholangiopancreatic disease, excluding cholelithiasis. Lemmel’s syndrome, juxtapapillary diverticula, periampullary duodenal In Lemmel was the first to report the presence of juxtapapillary.

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These diverticula are pseudo-diverticula consisting of outpouchings of mucosa, which lack a muscularis layer. Other surgical options would include diverticulectomy or bilodigestive anastomosis. Alexander Muacevic and John R Adler. Periampullary diverticula PAD refer to extraluminal outpouchings of duodenal mucosa syndrme develop within the radius of 2 to 3 cm from the ampulla of Vater 1.

Management of complicated duodenal diverticula. Lemmel syndrome was first described in by Lemmel as obstructive jaundice in the absence syndromme gallstones due to a periampullary duodenal diverticulum [ 1 ].

Obstructive jaundice can develop secondary to periampullary diverticula without choledocholithiasis in the setting of Lemjel syndrome [ 3 ]. Rarely, obstructive jaundice can develop secondary to PAD in the syndroms of choledocholithiasis or tumor and is termed Lemmel’s syndrome 2. Duodenal diverticula are pseudo-diverticula consisting of extraluminal sac-like out-pouchings of the duodenal mucosa which lack syncrome muscularis layer [ 2 ].

Contrast-enhanced reformatted images of the abdomen and pelvis demonstrate A an inflamed periampullary diverticulum, which obstructs the common bile duct arrow. Other authors advocate adding a gastrointestinal bypass, especially if there is local inflammation or risk of diverticular perforation. It is uncommon for duodenal diverticulum to become inflamed. Although PAD usually do not cause symptoms, it can serve as a source of obstructive jaundice even when choledocholithiasis or tumor is not present.


MRCP demonstrated mild distension of the gallbladder with several calculi. Regarding treatment, surgical excision of the diverticulum is appropriate in certain clinical scenarios.

Oxford University Press is a department of the University of Oxford. Unable to process the form. Sometimes these diverticula can be filled with fluid and misdiagnosed as a pancreatic abscess, cystic neoplasm in syndromr pancreatic head, or as a metastatic lymph node [ 8 ].

All Published work is licensed under a Creative Commons Attribution 4. This can be recurrent or complicated by cholangitis, which is attributed to mechanical compression of the lmmel bile duct by diverticulum [ 6 ]. Histoire Acad R Sci Paris.

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Lemmel syndrome occurs when a duodenal diverticulum causes obstructive jaundice due to a mechanical obstruction of the common bile duct. About Blog Go ad-free. Shocket E, Simon SA.

Hepatogastroenterology, 53pp. On duodenoscopy, the major duodenal papilla with a lemmsl orifice was located in the periampullary duodenal diverticulum Image 2. Lemmel’s syndrome, an unusual cause of abdominal pain and jaundice by impacted intradiverticular enterolith: Duodenal diverticula most commonly occur within 3 cm of the ampulla of Vater, and sjndrome diverticula are termed periampullary diverticula PAD [ 8 ].

Association of periampullary diverticula with primary choledocholithiasis. Removal of common bile duct CBD stone.

Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

Nihon Syndrom Igakkai Zasshi. Third, the distal common bile duct or ampulla can be compressed mechanically by periampullary diverticula as occurs in our case [ 7 ].

Find articles by Sang Woo Lee. Catheter ablation for Wolff-Parkinson-White syndrome with coronary sinus diverticulum in a year-old boy. More on this topic Massive hiatus hernia complicated by syndorme. After the procedure, the patient no longer complained of abdominal pain, her liver enzyme was normalized, and she was discharged without any complication.


A year-old previously healthy woman presented to the emergency department without any significant past medical history. An ultrasound of abdomen displayed distension of the gallbladder with a large volume sydrome stones and sludge, as well as intra- and extra-hepatic biliary ductal dilatation.

Log in Sign up. In addition, the stomach and proximal duodenum were dilated with air-fluid levels concerning for proximal obstruction. An associated choledochojejunostomy also decreases this risk of injury. Second, PAD many cause dysfunction in the sphincter of Oddi 5. A case of left ventricular diverticulum: Lemjel admission, coronal heavily T2-weighted single-shot rapid acquisition with relaxation enhancement magnetic resonance cholangiopancreatography MRCPcarried out without secretin injection, demonstrated a lateral compression of the distal common bile duct Image 1.

Endoscopic nasobiliary drainage tubogram obtained after decompression of the PAD demonstrates resolved extrinsic compression B. lemmmel

Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

The most common site for diverticula is the colon, followed by the duodenum [ 6 ]. Find articles by Hyo Sung Kang. Journal List Cureus v.

Articles from Cureus lemkel provided here courtesy of Cureus Inc. Lemmel syndrome was first described in by Lemmel as obstructive jaundice in the absence of gallstones due to a periampullary duodenal diverticulum. Beta-glucuronidase activity in the bile of gallstone patients both with and without duodenal diverticula. Biliary pancreatitis in a duplicate gallbladder: View large Download slide. The results of her liver function test were as follows: