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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She had no chest pain, dyspnoea, cough or urinary symptoms. Non-pancreaticobiliary complications include haemorrhage, diverticulitis, perforation or fistula formation. Enterolith, Lemmel’s Syndrome, Periampullary Diverticulitis.

Consent was obtained by all participants in this study. J Visc Surg,pp. Intrahepatic biliary ductal dilation is significantly improved open arrow. About Blog Go ad-free.

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Contrast-enhanced reformatted images of the abdomen and pelvis demonstrate A an inflamed periampullary diverticulum, which obstructs the common bile duct arrow. These include duodenal diverticula causing dysfunction of the sphincter of Oddi as well as compression of the common bile duct by duodenal diverticula. Author information Article notes Copyright and License information Disclaimer. Find articles by Hyo Sung Kang.

Endoscopic manometry of the sphincter of Oddi in patients with Lemmel’s syndrome. A gastroduodenoscopy revealed a large periduodenal diverticulum in D2 Fig.

CT scan and MRCP will demonstrate periampullary diverticula on the medial wall of the second portion of the duodenum. This article has been cited by other articles in PMC.

Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

Combination of electrohydraulic lithotripsy and laparoscopy for gallbladder access in type III Mirizzi syndrome. There were no findings of bile duct stones or dilatation of the common bile duct. The pathology study revealed no pathological alterations in the walls of the diverticulum.


She remains clinically and radiographically disease free after the last procedure. Ampullary duodenal diverticulum and cholangitis. There was intra- and extra-hepatic biliary dilatation to the level of the ampulla. Endoscopic sphincterotomy is the treatment of choice in cases of biliary or pancreatic complications.

The relationship between juxtapapillary syndrrome diverticula and disorders of the biliopancreatic system: PAD at this time was neither distended nor filled with enterolith.

MRCP and ERCP in Lemmel Syndrome

Computed tomography of the abdomen showed several gallbladder stones and gallbladder wall thickening. National Center for Biotechnology InformationU. Pancreaticobiliary complications can include recurrent gallbladder or bile sundrome stones, obstructive jaundice, acute pancreatitis or ascending cholangitis [ 9 ].

Received Oct 5; Accepted Dec Although CBD was explored in our case, no other etiology of obstructive jaundice lemme be identified other than extrinsic compression by distended PAD. The patient was subsequently made nil per os NPO and an NG tube was placed for syndorme and suction.

Lemmel’s syndrome, an unusual cause of abdominal pain and jaundice by impacted intradiverticular enterolith: Interestingly, an unusual appearance to the kidneys was recorded with multiple microcystic changes in both kidneys, which is typically reported in patients with lithium induced renal disease.

Extrinsic compression of the common bile duct may require surgery. In our case, blind loop created by Billroth II anastomosis seems to have provided a static environment favoring enterolith formation within the PAD.


Tham TC, Kelly M. Jong Jin Hyun, MD. Close mobile search navigation Article navigation. Three-dimensional reconstruction showing dilatation of the proximal common hepatic bile duct with distal narrowing due to extrinsic compression by a large duodenal diverticulum arrow.

Please review our privacy policy. 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. Second, PAD many cause dysfunction in the sphincter of Oddi 5.

Synonyms or Alternate Spellings: Treatment is generally not recommended in asymptomatic patients or would be conservative management in pauci-symptomatic patients.

Discussion Gastrointestinal diverticula are outpouchings of the intestinal wall, which can occur anywhere throughout the gastrointestinal tract and are most often found in the colon, followed by the duodenum.

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 syndrme Crohn’s disease or tuberculosis 8.

Case 1 Case 1. Follow-up computed tomography scan taken about 6 months after enterolith removal shows an ovoid stone white arrow within the Syhdrome A.