Lemmel’s Syndrome Secondary to Common Bile Duct Compression by an Inflamed Duodenal Diverticulum

Abstract

A 50-year-old female presented with acute epigastric abdominal pain, diarrhea, nausea, and vomiting for two days. Laboratory data showed hyperbilirubinemia and leukocytosis. Abdominal imagining was concerning for a pancreatic head/uncinate process lesion concerning a pancreatic neoplasm. Subsequent esophagogastroduodenoscopy with endoscopic ultrasound and endoscopic retrograde cholangiopancreatography found the major papilla adjacent to an inflamed and infected duodenal diverticulum, which was extrinsically compressing the distal common bile duct, causing biliary obstruction and common bile duct dilation. These findings are consistent with a diagnosis of Lemmel’s syndrome. A biliary sphincterotomy was performed to relieve the obstruction and one temporary plastic biliary stent was placed into the common bile duct. The duodenal diverticulitis was treated with antibiotics for 10 days and the patient made a good recovery.

Lemmel syndrome: an unusual cause of biliary obstruction secondary to a duodenal juxta-ampullary diverticulum: a report of two cases

“…Most duodenal diverticula (95%) are asymptomatic [5] . They are discovered incidentally in 22% of cases [1 , 6] .…”

“…Lemmel's syndrome is defined by extrinsic compression of the distal common bile duct by a periampullary diverticulum in the absence of choledocholithiasis or pancreaticobiliary tumor [5] . There are few case reports on this condition, first named in 1934 by Dr. Gerhard Lemmel [5] .…”

“…Lemmel's syndrome is defined by extrinsic compression of the distal common bile duct by a periampullary diverticulum in the absence of choledocholithiasis or pancreaticobiliary tumor [5] . There are few case reports on this condition, first named in 1934 by Dr. Gerhard Lemmel [5] . Lemmel's syndrome's clinical symptoms are nonspecific, mainly manifested by right hypochondrial pain, recurrent attacks of acute abdominal pain, and jaundice [1 , 7] .…”

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

“…[ 2 ]. Named after Dr. Gerhard Lemmel in 1934, the possible existence of a periampullary diverticulum (PAD) could be the likely culprit of Lemmel's syndrome [ 2 , 3 ]. Periampullary diverticula (PAD) can be explained as extraluminal outpouchings of the duodenum that originate within 2-3cm from the ampulla of Vater [ 4 ].…”

“…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 ]. The primary diagnostic tools are ERCP or EUS, and non-invasive testing like CT scans support the diagnosis [ 3 ].…”