Treatment Options of Lemmel’s Syndrome: A Case of Benign Obstructive Jaundice in The Elderly

Prasetyaningtyas, Abigail; Rahman, Perdana Aditya; Sudoyo, Aru Wisaksono; Fauzi, Achmad

doi:10.24871/1622015120-125

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…When endoscopic or conservative treatment fails, surgical treatment is usually reserved [ 8 ]. Endoscopic sphincterotomy is the initial treatment for biliopancreatic complications of PDDs and is successful in 95% of cases.…”

Section: Discussionmentioning

confidence: 99%

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Lemmel’s Syndrome: A Report of Two Cases at the Hospital General Dr. Manuel Gea Gonzalez in Mexico City

M.D.¹,

Lailson²,

Villarreal³

et al. 2023

Cureus

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The term ¨Lemmel Syndrome¨ is used to describe obstructive jaundice that is secondary to periampullary duodenal diverticula (PDD) in the absence of choledocholithiasis or neoplasia. PDD is found in 22% of the population. According to our knowledge, only two cases of Lemmel syndrome have been reported in Mexico. We report two cases of Lemmel syndrome in a 94-year-old and a 71-year-old woman who presented with clinical jaundice. One of the cases was treated with endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy, balloon sweep, and the placement of a plastic biliary prosthesis, and the other with laparoscopic biliodigestive bypass and a manual lateral end choledocho-duodenal anastomosis. Our objective is to expand the information on this rare pathology to take it into account as a diagnostic possibility of jaundice and to define appropriate management, which can be endoscopic or surgical.

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Section: Discussionmentioning

confidence: 99%

“…Diverticulectomy is associated with a high risk of injury to the bile and pancreatic ducts. The retroperitoneal location of this second duodenal part makes surgical procedures in this part complex [ 8 ]. The risk of duodenal fistula is high and is associated with a mortality rate of 20% to 30% [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Lemmel’s Syndrome: A Report of Two Cases at the Hospital General Dr. Manuel Gea Gonzalez in Mexico City

M.D.¹,

Lailson²,

Villarreal³

et al. 2023

Cureus

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Case report: Lemmel syndrome-aggravated by consumption of fatty food

Pokharel,

Gurung,

Khadka

et al. 2024

Annals of Medicine &Amp; Surgery

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Introduction and Importance: One of the very rare causes of obstructive jaundice, Lemmel’s syndrome is caused due to biliary mechanical compression by a juxtapapillary diverticulum. It is defined as obstructive jaundice due to juxtapapillary diverticulum in the absence of cholelithiasis, periampullary tumours or other detectable obstacles. It is extremely rare syndrome therefore studies need to be done for proper diagnosis and management. Case Presentation: Our patient, a 73-year-old woman, gave a history of recent acute right hypochondriac pain that had subsided the day before. Lab investigations were performed and liver enzymes were found to be significantly raised. An endoscopy followed by an endoscopic ultrasound was performed for further diagnosis which showed the diverticulum outpouching from the duodenum. MRCP was then performed which revealed a dilated common bile duct and common hepatic duct, with tapering at the distal end, most likely to be a stricture. Lemmel syndrome was identified based on the clinical presentation and imaging results. A dilated common bile duct, and two large duodenal diverticula with interdiverticular papilla was discovered during the patient’s endoscopic ultrasound which was performed by the gastrointestinal team. Clinical Discussion: Duodenal diverticula are the second most common site of diverticula after colon with an incidence of 1-5% in radiological series3. Lemmel’s syndrome is a rare cause of obstructive jaundice associated with juxtapapillary diverticulum. With a low incidence rate, only a few cases of Lemmel’s syndrome are reported with the first case reported in 1934 by Lemmel.4 Imaging techniques such as barium meal, EUS, ERCP, or magnetic resonance cholangiopancreatography are used to confirm the diagnosis. Our observations demonstrate that the diverticulum which is often found on the medial wall of the second half of the duodenum and contains bezoar, compresses the distal common bile duct laterally. Nowadays, ERCP and EUS are used to confirm the diagnosis.5 Only symptomatic periampullary duodenal diverticulum(PDD) requires conservative or surgical therapy. The first line of treatment for biliopancreatic PDD problems is endoscopic sphincterotomy, which is 95% effective.6 Conclusion: Lemmel syndrome occurs due to the compression of the common bile duct by a duodenal diverticulum. Imaging including CT scan and MRCP are important for the diagnosis of this syndrome. Treatment modalities are not the same for each patient, however.

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Treatment Options of Lemmel’s Syndrome: A Case of Benign Obstructive Jaundice in The Elderly

Abstract: Lemmel's syndrome, also known as duodenal diverticulum obstructive jaundice, is a rare cause of benign obstructive jaundice that should be included in the differential diagnosis of biliary obstruction when PAD is present, in the absence

Cited by 2 publications

References 18 publications

Lemmel’s Syndrome: A Report of Two Cases at the Hospital General Dr. Manuel Gea Gonzalez in Mexico City

Lemmel’s Syndrome: A Report of Two Cases at the Hospital General Dr. Manuel Gea Gonzalez in Mexico City

Case report: Lemmel syndrome-aggravated by consumption of fatty food

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