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.

Author: Dobei Vumi
Country: Finland
Language: English (Spanish)
Genre: Environment
Published (Last): 15 February 2014
Pages: 335
PDF File Size: 3.99 Mb
ePub File Size: 8.43 Mb
ISBN: 421-7-91836-685-6
Downloads: 93900
Price: Free* [*Free Regsitration Required]
Uploader: Faegore

Hepatogastroenterology, 53pp. MRCP demonstrated mild distension of the gallbladder with several calculi. The remaining laboratory values were unremarkable. Third, distal CBD or ampulla can be directly compressed mechanically by Syndrlme that is usually filled with enterolith or bezoar 67. Therefore, the enterolith, bezoar, or food material within the PAD is frequently evacuated and thus, the symptom could be intermittent.

It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide.

J Am Coll Surg,pp. Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography. She had a pound unintentional weight loss, fatigue, and weakness that began three months prior. Her examination was notable for an end colostomy in the left lrmmel fossa with a reducible para-stomal hernia. A case of duodenal diverticulum mimicking a peripancreatic abscess.

Duodenal diverticula are pseudo-diverticula consisting of extraluminal sac-like out-pouchings of the duodenal mucosa which lack a muscularis layer [ 2 ]. Although MRCP with secretin stimulation could demonstrate a periampullary duodenal diverticulum which was filled with secreted pancreatic juice [ 4 ], a routine MRCP without secretin injection has low sensitivity for the detection of a periampullary duodenal diverticulum [ 5 ].

CiteScore measures average citations received per document published. T2-weighted coronal MR images of the abdomen re-demonstrate A a periampullary duodenal diverticulum with surrounding inflammatory changes arrow.

There was a problem providing the content you requested

Lateral compression of the distal common bile duct on MRCP without secretin injection implies the possibility of periampullary duodenal diverticulum. PAD are largely asymptomatic but they sometimes can cause both pancreaticobiliary and non-pancreaticobiliary complications. J Hepatobiliary Pancreat Surg. Report of a case of duodenal diverticulum containing gallstones. These diverticula are pseudo-diverticula consisting of outpouchings of mucosa, which lack a muscularis layer.


To date, there are few published cases, and the etiopathogenesis has not been completely established. A year-old male was referred for jaundice and general fatigue. Related articles in PubMed Pathophysiological mechanisms of diabetic cardiomyopathy and the therapeutic potential of epigallocatechingallate.

Database connection failed!

Regarding treatment, surgical excision of the diverticulum is appropriate in certain clinical scenarios. Lemmel syndrome was first described in by Lemmel as obstructive jaundice in the absence of gallstones due to a periampullary duodenal diverticulum [ 1 ].

Enterolith formation within the duodenal diverticula is known to be facilitated in the static environment such as a blind loop after gastrectomy or proximal portion of stricture formed by Crohn’s disease or tuberculosis 8. Biliary pancreatitis in a duplicate gallbladder: Here, a case of Lemmel syndrome is presented. This item has received. Intrahepatic biliary ductal dilation is significantly improved open arrow.

Diverticulitis of the duodenum: Please review our privacy policy. Once the papilla was located with a Fogarty catheter through the cystic duct, the diverticulum was dissected at its neck; the common bile duct was dissected above the area being compressed by the diverticulum, confirming the discharge of clean bile; the bile duct was ligated distally and reconstructed using Roux-en-Y choledochojejunostomy.

Open in a separate window. The existence of a juxtapapillary diverticulum is associated with the elevated incidence of biliopancreatic disease due to, on the one hand, the extrinsic compression of the diverticulum itself on the bile duct Lemmel’s syndrome and, on the other hand, it may favor bacterial overgrowth and consequently the production of biliary lithiasis due to beta-glucuronidase activity, in addition to inducing sphincter of Oddi dysfunction, leading to stasis and biliary reflux from the duodenum to the common bile duct.


An year-old lady presented to the emergency department with a 6-week history of general deterioration. Log in Sign up. The patient underwent an MRCP which demonstrated mild distension of the gallbladder with several calculi. Operative management of symptomatic duodenal diverticula.

Since ERCP did not guarantee definitive treatment, the patient was referred to our surgical service. Duodenal diverticula most commonly occur within 3 cm of the ampulla of Vater, and these diverticula are termed periampullary diverticula PAD [ 8 ]. A rare anatomical variation of the biliary tree. Herein, we report a case Lemmel’s syndrome that was successfully managed endoscopically.

A case of left ventricular diverticulum: B An axial slice slightly more cephalad shows dilated intrahepatic bile ducts open arrow. You can change the settings or obtain le,mel information by clicking here. Pathologic mechanisms through which Lemmel’s syndrome is thought to occur include the following.

MRCP and ERCP in Lemmel Syndrome | Insight Medical Publishing

All content published within Cureus is intended only for educational, research and reference purposes. A case of Mirizzi syndrome that was successfully treated by laparoscopic choledochoplasty using a gallbladder patch. However, many patients with Lemmel syndrome do present with some form of symptoms related to biliary obstruction secondary to extrinsic compression of the common bile duct and treatment may be warranted.

Synvrome from Cureus are provided here courtesy syndromr Cureus Inc. The patient was being studied by the gastroenterology department after having presented several self-limiting episodes of abdominal pain in the right hypochondrium and epigastrium, fever and jaundice with leukocytosis, as well as a cytolytic and cholestatic pattern seen in the lab work-up.