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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Therefore, high index of suspicion is mandatory to arrive at a correct diagnosis in these patients.

MRCP and ERCP in Lemmel Syndrome

The clinical significance of the duodenal diverticulum Die klinische Bedeutung der Duodenaldivertikel. MR cholangiopancreatography of Mirizzi syndrome and Lemmel syndrome.

Small bowel obstruction due to enterolith bezoar formed in a duodenal diverticulum: About Blog Go ad-free. Find articles by Ja Seol Koo.

MRCP and ERCP in Lemmel Syndrome | Insight Medical Publishing

Thank you for updating your details. Lateral compression of the distal common bile duct on MRCP without secretin injection implies the possibility of periampullary duodenal diverticulum.

Regarding treatment, surgical excision of the diverticulum is appropriate in certain clinical scenarios. A unique case of xanthogranulomatous cholecystitis complicated by multiple liver abscesses and portal vein and hepatic artery thrombosis and occlusion.

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Clin Res Hepatol Gastroenterol. After removal of the enterolith within the PAD, all her symptoms resolved. Sign In or Create an Account.

After completion of enterolith removal, filling defect is no longer seen within the PAD C.


Juxtapapillary duodenal diverticula and pancreatobiliary disease. Endoscopic manometry of the sphincter of Oddi in patients with Lemmel’s syndrome.

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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 syndroke the diverticulum, confirming syndromme discharge of clean bile; the bile duct was ligated distally and reconstructed using Roux-en-Y choledochojejunostomy.

For commercial re-use, please contact journals. Eur J Radiol ; However, many sundrome 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.

Rarely, obstructive jaundice can develop secondary to PAD in the absence of choledocholithiasis or tumor and is termed Lemmel’s syndrome 2.

Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional.

Other authors advocate adding a gastrointestinal bypass, especially if there is local inflammation or risk of diverticular perforation. Case presentation A year-old previously healthy woman presented to the emergency department without any significant past medical history. When these diverticula are located within cm of the ampulla of Vater they are termed periampullary diverticula [ 1 ].

To date, there are few published cases, and the etiopathogenesis has not lemmfl completely established. Arch Verdauungskrht ; When a biliary obstruction is present, excision of the diverticulum can be done, but the procedure is difficult and associated with significant mortality [ 6 ].

Lemmel syndrome | Radiology Reference Article |

Consent was obtained by all participants in this study. These include duodenal diverticula causing dysfunction of the sphincter of Oddi as well as compression of the common bile duct by duodenal diverticula. This finding is sjndrome in line art to better delineate the anatomical relationship C.


T2-weighted coronal MR images of the abdomen re-demonstrate A a periampullary duodenal diverticulum with surrounding inflammatory changes arrow. Contrast-enhanced Axial CT of the Upper Abdomen Pre-Treatment Contrast-enhanced axial CT images of the upper abdomen demonstrate A a periampullary duodenal diverticulum with surrounding inflammatory changes consistent with diverticulitis, including wall thickening and fat stranding arrow.

Author information Article notes Copyright and License information Disclaimer. Imaging is very important to pemmel identify and diagnose Lemmel syndrome, and awareness of this condition may prevent mismanagement. Support Center Support Center. Recognition of this condition is important, as delayed diagnosis can result in unnecessary further investigations.

Management of complicated duodenal diverticula. Computed tomography of the abdomen showed several gallbladder stones and gallbladder wall thickening.

Association of periampullary duodenal diverticula with bile duct stones and with technical success of endoscopic retrograde cholangiopancreatography. Lemmel syndrome was first described in by Lemmel as obstructive jaundice in the absence of gallstones due to a periampullary duodenal diverticulum [ 1 ]. Sao Paulo Med J. Excision of a juxtapapillary duodenal diverticulum causing biliary obstruction: Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: