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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Shndrome, the authors experienced an unusual case of abdominal pain and obstructive jaundice due to extrinsic compression of mid common bile duct CBD by distended PAD filled with pus-like material as a result of impacted intradiverticular enterolith at the PAD syndorme. A year-old male was referred for jaundice and general fatigue. When the CBD stone was removed by ERCP, the stone proved to be brown pigment sludge stone that typically forms in the presence of ascending infection Fig.

Clin Res Hepatol Gastroenterol.

Lemmel syndrome | Radiology Reference Article |

There was a grid-iron incision in the right iliac fossa. Focal outpouching of the duodenum adjacent to the papilla in 2 nd part of the duodenum causing compression of the Lemel. The authors have declared that no competing interests exist. Endoscopic nasobiliary drainage tubogram obtained after decompression of the PAD demonstrates resolved extrinsic compression B.

Sao Paulo Med J. The clinical significance of the duodenal diverticulum. Endoscopy, ldmmelpp. Enterolith formation within the duodenal diverticula is known to be facilitated in the static environment such as a blind loop after gastrectomy or proximal portion of stricture formed by Crohn’s disease or tuberculosis 8.


This re-demonstrated a periampullary duodenal diverticulum with adjacent inflammatory changes.

The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: Ignoring the possibility of same can lead to repetitive jaundice and syndorme cholangitis, increasing the mortality and morbidity risk for the patient.

Non-pancreaticobiliary complications include haemorrhage, diverticulitis, perforation or fistula formation.

MRCP and ERCP in Lemmel Syndrome

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Management of complicated duodenal diverticula. Am J Surg, 26pp. Lemmel’s syndrome, an unusual cause of abdominal pain and jaundice by impacted intradiverticular enterolith: J Hepatobiliary Pancreat Surg.

Lemmel syndrome is a rare cause of biliary obstruction. Magnetic resonance cholangiopancreatography showing the diverticulum arrow medial to the duodenum D in axial views. Combination of electrohydraulic lithotripsy and laparoscopy for gallbladder access in type III Mirizzi syndrome.

Therefore, the enterolith, bezoar, or food material within the PAD is frequently evacuated and thus, the lenmel could be intermittent. CT scan and MRCP will demonstrate periampullary diverticula on the medial wall of the second portion of the duodenum. J Hepatobiliary Pancreat Surg.

After admission, coronal heavily T2-weighted single-shot rapid acquisition with relaxation enhancement magnetic resonance cholangiopancreatography MRCPcarried out without secretin injection, demonstrated a lateral syndromr of the distal common bile duct Image 1. Citing articles via Google Scholar. Among these complications, hepatocholangiopancreatic disease can seldomly occur in the absence of choledocholithiasis and is termed Lemmel’s syndrome 2. The results of her liver function test were as follows: The pathology study revealed no pathological alterations in the walls of the diverticulum.


After removal of the enterolith within syndrme PAD, all her symptoms resolved. Periampullary duodenal diverticula PAD are those that develop within a 2—3 cm radius from the ampulla of Vater [ 3 ].

MRCP and ERCP in Lemmel Syndrome | Insight Medical Publishing

Second, PAD many cause dysfunction in the sphincter of Oddi 5. Syndromee Jin Hyun, MD. Acta Lemkel Belg ; Author information Article notes Copyright and License information Disclaimer. Lemmel’s syndrome as a rare cause of obstructive jaundice. On axial CT scan, a high attenuated stone density with internal air black arrow is seen on distal common bile duct CBD A.

Diverticulitis of the duodenum: Received Oct 5; Accepted Dec An yr-old woman came to the emergency room with obstructive jaundice and cholangitis. Continuing navigation will be considered as acceptance of this use.

They are more frequently located in the ,emmel portion of the duodenum, close to the ampulla of Vater juxtapapillary due to the weakness of the wall in this area. PAD at this time was neither distended nor filled with enterolith.

SRJ is a prestige metric based on the idea that not all citations are the same. Tomita R, Tanjoh K.