Lemmelʼs Syndrome: A Rare Phenomenon Causing Obstructive Jaundice

Figueroa-Rivera, Ivonne; Class-Vazquez, Walisbeth; Martín, José

doi:10.14309/00000434-201710001-01331

Cited by 4 publications

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“…Cases can be classified as pancreaticobiliary or non-pancreaticobiliary. Pancreaticobiliary complications of PAD center around the obstructive capabilities of the diverticulum, and can manifest as obstructive jaundice, cholangitis, or pancreatitis [1,3]. Non-pancreaticobiliary complications include hemorrhage, fistula formation, perforation, or enterolith formation, which occur secondary to inflammation [3].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of a PAD is 1%-27% [1]. They usually result in malfunctioning of the sphincter of Oddi, or mechanically obstruct outflow through the common bile duct [3]. Clinical symptoms consist of right upper quadrant pain, and laboratory workup would reveal elevated bilirubin levels, elevated liver enzymes, and/or pancreatic enzymes depending on involvement of the ampulla of Vater [4].…”

Section: Introductionmentioning

confidence: 99%

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Lemmel’s Syndrome: Usual Presentation of an Unusual Diagnosis

Bernshteyn¹,

Rao²,

Sharma³

et al. 2020

Cureus

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Lemmel's syndrome causes obstructive jaundice in the absence of stones or tumors. The most common cause is the presence of periampullary diverticula which arise within 2-3 cm from the ampulla of Vater. Diverticula may be extramural or intramural. Despite current practice of obtaining imaging studies such as ultrasound, CT, and MRI, endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard diagnostic test. Lemmel's syndrome should be considered when pancreaticobiliary disease is suspected. We present a case in which our patient presented with abdominal pain, fever, and transaminitis who underwent ERCP which was successful in diagnosis of Lemmel's syndrome and its treatment. Although rare, it is imperative for physicians to recognize this syndrome in order to deliver prompt care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lemmel’s Syndrome: Usual Presentation of an Unusual Diagnosis

Bernshteyn¹,

Rao²,

Sharma³

et al. 2020

Cureus

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“…[7][8] Las complicaciones pancreatobiliares pueden manifestarse como ictericia obstructiva, colangitis aguda o pancreatitis aguda. [7][8] Los mecanismos postulados en la patogénesis del síndrome de Lemmel incluyen: a) irritación mecánica directa del DDP, que provoca inflamación crónica de la ampolla de Vater y que conduce a fibrosis, b) disfunción del esfínter de Oddi, c) compresión mecánica del colédoco o de la ampolla de Vater por el DDP, lo que aumenta la presión en el conducto biliar o en el conducto pancreático. 1,4,9 Los estudios por imágenes nos permiten detectar la presencia de los DDP y excluir otras etiologías.…”

Section: Discussionunclassified

Síndrome de Lemmel: una causa infrecuente de colangitis aguda

Moreno¹,

Nano

Vega

2022

Acta gastroenterol. latinoam.

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Lemmel syndrome is a rare entity that causes biliary obstruction due to compression of the common bile duct by a periampullary diverticulum. It can manifest as acute cholangitis and is often underdiagnosed. However, once identified, it can be successfully treated with endoscopic retrograde cholangiopancreatography, being one of the most used methods. Lemmel syndrome should be considered in elderly patients with a diagnosis of periampullary duodenal diverticulum, once the presence of choledocholithiasis and pancreatobiliary neoplasms have been ruled out.

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“…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 ]. Although mostly asymptomatic, underreporting of symptomatic duodenal diverticula using imaging modalities is a prevalent issue mostly caused by the lack of pathognomonic signs and symptoms [ 7 ].…”

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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Lemmelʼs Syndrome: A Rare Phenomenon Causing Obstructive Jaundice

Cited by 4 publications

References 0 publications

Lemmel’s Syndrome: Usual Presentation of an Unusual Diagnosis

Lemmel’s Syndrome: Usual Presentation of an Unusual Diagnosis

Síndrome de Lemmel: una causa infrecuente de colangitis aguda

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

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