An unusual cause of obstructive jaundice: Lemmel’s syndrome

Bellamlih, Habib; Echchikhi, M.; Farouki, Ayman El; Billah, Nabil Moatassim; Nassar, I.

doi:10.1259/bjrcr.20200166

Cited by 6 publications

(7 citation statements)

References 8 publications

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“…In one case, CT imaging alone was sufficient to make the diagnosis, appearing as an outpouching of the intestinal wall containing air, an air-fluid level, or debris [5]. Unfortunately, abdominal CT exams lack specificity, and a duodenal diverticula may be falsely interpreted as a possible pancreatic neoplasm or pseudocyst, as was the case for our patient [3, 11]. Thus, a suspected case of Lemmel syndrome seen on CT scan may require a more definitive study such as MRCP or endoscopy.…”

Section: Discussionmentioning

confidence: 86%

Diagnosis and Management of Lemmel Syndrome: An Unusual Presentation and Literature Review

Love

Yellen

Melitas

et al. 2022

Case Rep Gastroenterol

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Lemmel syndrome is a rare clinical entity characterized by the presence of a periampullary duodenal diverticulum resulting in compression and dilatation of the pancreatic and common bile ducts, accompanied by obstructive jaundice. Gastric outlet obstruction is not a known complication of this syndrome, and there are no standardized approaches to its treatment. We present the first case of Lemmel syndrome presenting as gastric outlet obstruction and provide the results of a systematic literature review.

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Section: Discussionmentioning

confidence: 86%

Diagnosis and Management of Lemmel Syndrome: An Unusual Presentation and Literature Review

Love

Yellen

Melitas

et al. 2022

Case Rep Gastroenterol

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“…Se han publicado casos de presentación inusual, como el de un paciente que sufrió un trauma cerrado de abdomen con el desarrollo posterior de síndrome de Lemmel 13 , o el de dos pacientes con antecedente de gastrectomía subtotal Billroth 14,15 , en quienes se consideró que el asa duodenal ciega pudo causar un aumento de la presión, favoreciendo la formación de divertículos, el acumulo de detritos dentro de él, y la formación de bezoares o cálculos que causaron el síndrome de Lemmel. Los exámenes de laboratorio son de gran importancia, encontrando un patrón colestásico en el perfil hepático, que no es específico para el síndrome de Lemmel. Las imágenes diagnósticas son de mucha utilidad para establecer el diagnóstico, aunque también presentan limitaciones, como la ecografía que en los casos revisados no logró establecer la presencia del síndrome, siendo informada como normal o solamente con dilatación de la vía biliar 16 .…”

Section: Discussionunclassified

Síndrome biliar obstructivo no litiásico o de Lemmel ¿Es tan infrecuente como parece?

Ceballos¹,

Hoyos-Yepes²,

Felipe³

et al. 2023

Rev Colomb Cir

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Introducción. Aproximadamente el 5 % de los divertículos duodenales pueden causar síntomas y el 1 % presentar complicaciones, siendo la colangitis la más frecuente. El síndrome de Lemmel corresponde a un tipo de ictericia obstructiva intermitente, asociado a la presencia de divertículos periampulares y disfunción del esfínter de Oddi, sin presencia de coledocolitiasis. Método. Se realizó una revisión sistemática de la literatura en Pubmed, Google Académico y ProQuest, con los términos: síndrome de Lemmel, divertículo duodenal sintomático e ictericia obstructiva intermitente. Resultados. Se encontraron 38 casos, siendo España el país con mayor número, seguido de México, Japón y Colombia. No hay diferencias de distribución con respecto al género. El tratamiento más frecuentemente empleado fue la colangio pancreatografia retrógrada endoscópica. Conclusión. El síndrome de Lemmel es poco frecuente, sin un cuadro clínico especifico, con un incremento en los casos informados en los últimos años, posiblemente debido a la mejor disponibilidad de métodos diagnósticos. Es más frecuente en pacientes en la octava década de la vida y su tratamiento generalmente es endoscópico.

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“…Duodenal diverticula (DD) are referred to as periampullary, peripapillary, or paravaterian diverticula (PAD) when they develop within 2-3 cm of the ampulla of Vater [ 5 ]. It can be divided into three categories depending on where the papilla is in relation to the diverticulum.…”

Section: Discussionmentioning

confidence: 99%

“…Periampullary diverticula (PAD) can be explained as extraluminal outpouchings of the duodenum that originate within 2-3cm from the ampulla of Vater [ 4 ]. Such outpouchings are also known as peripapillary or paravaterian diverticula, in addition to being called PAD [ 5 ]. The incidence of PAD ranges from 1% to 27% [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

A Rare Presentation of Duodenal Diverticulum Causing Obstructive Jaundice: Lemmel's Syndrome

Shrivastava¹,

Nagendra²,

Varma³

et al. 2023

Cureus

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Lemmel syndrome is an uncommon pancreaticobiliary consequence of duodenal diverticula. We herein present a case of an 80-year-old male who presented with upper abdominal discomfort. Based on lab values and relevant clinical history, a diagnosis of obstructive jaundice was made. A contrast-enhanced CT scan of the abdomen revealed gross dilatation of intra-hepatic and extra-hepatic bile duct, cystic duct, common bile duct, major and minor pancreatic duct. A contrast-filled outpouching was seen from the medial wall of the second part of the duodenum with duodenal diverticulum and papilla within it. The abrupt termination of the common bile duct and main pancreatic duct adjacent to the thickened wall of the diverticulum was the cause of the patient's pancreaticobiliary obstruction. In the absence of cholelithiasis or tumor, the duodenal diverticulum that manifests as obstructive jaundice is known as Lemmel syndrome. Prompt identification of Lemmel syndrome can avoid dangerous complications and unnecessary investigations. Gallstones, cholangitis, and bile duct stones are more common in patients with duodenal diverticula. Treatment depends on patient presentation and may involve conservative management, surgical procedures in the form of excision of the diverticulum, or even endoscopic sphincterotomy or stenting.

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An unusual cause of obstructive jaundice: Lemmel’s syndrome

Cited by 6 publications

References 8 publications

Diagnosis and Management of Lemmel Syndrome: An Unusual Presentation and Literature Review

Diagnosis and Management of Lemmel Syndrome: An Unusual Presentation and Literature Review

Síndrome biliar obstructivo no litiásico o de Lemmel ¿Es tan infrecuente como parece?

A Rare Presentation of Duodenal Diverticulum Causing Obstructive Jaundice: Lemmel's Syndrome

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