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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There was intra- and extra-hepatic biliary dilatation to the level of the ampulla.
Table 1 outlines the admission and discharge liver function tests. Manabe T, Yu GS. Treatment is generally not recommended in asymptomatic patients or would be conservative management in pauci-symptomatic patients.
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Die KlinischeBedeutung der Duodenal Divertikel. Laboratory values revealed that hemoglobin and bilirubin metabolites were normal, but inflammatory markers, including CRP, were elevated. Barium studies can demonstrate this condition with contrast-filled outpouchings that arise from the medial side of the synrrome duodenum [ 9 ]. Among these complications, hepatocholangiopancreatic disease can seldomly occur in the absence of choledocholithiasis and is termed Lemmel’s syndrome 2.
Association of periampullary diverticula with primary choledocholithiasis. November Pages Therapeutic options in this situation run the gamut from endoscopic extraction of entrapped material, extracorporeal shock wave lithotripsy to surgery diverticulectomy or biliodigestive anastomosis 714 Acute obstructive cholangitis caused by an enterolith in a duodenal diverticulum.
This finding is depicted in line art to better delineate the anatomical relationship C. Another important consideration is that not synrrome forms of Lemmel syndrome can be attributed to extrinsic compression of the common bile duct CBD by periampullary diverticula.
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Obstructive jaundice can develop secondary to periampullary diverticula without choledocholithiasis in the setting of Lemmel syndrome [ 3 ]. Surg Laparosc Endosc Percutan Tech, 16pp. Follow-up computed tomography scan taken about 6 months after enterolith removal shows an ovoid stone white arrow within the CBD A.
There was a grid-iron incision in the right iliac fossa. Am J Surg, 26pp. Magnetic resonance cholangiopancreatography was performed, which revealed dilatation of the biliary tract as well as a large duodenal diverticulum with an air-fluid level in its interior that was displacing and compressing lwmmel main biliary tract, with no images suggestive of cholelithiasis or choledocholithiasis Figs.
This re-demonstrated a periampullary duodenal diverticulum with adjacent inflammatory changes. This can be recurrent or complicated by cholangitis, which is attributed to mechanical compression of the terminal bile duct by diverticulum [ 6 ]. However, many patients with Lemmel syndrome do present with some form of symptoms related to biliary obstruction secondary to extrinsic compression of the common bile duct and treatment may be warranted.
Lemmle An axial slice slightly more cephalad shows dilated intrahepatic bile ducts open lejmel.
Lemmel syndrome | Radiology Reference Article |
Laboratory examination only revealed slightly increased total bilirubin to 1. Duodenal oemmel most commonly occur within 3 cm of the ampulla of Vater, and these diverticula are termed periampullary diverticula PAD [ 8 ].
Most of these periampullary diverticuli remain asymptomatic and are diagnosed incidentally, but rarely can cause pancreaticobiliary or non-pancreaticobiliary complications. Pancreaticobiliary complications can include recurrent gallbladder or bile duct stones, obstructive jaundice, acute pancreatitis or ascending cholangitis [ 9 ].
Excision stndrome a juxtapapillary duodenal diverticulum causing biliary obstruction: CT and MR imaging findings in seven patients. We present a case of Lemmel syndrome secondary to duodenal diverticulitis lsmmel was successfully managed with nasogastric NG tube decompression set to suction as well as intravenous antibiotics, including syndromme and levofloxacin. Find articles by Hyo Sung Kang. The results of her liver function test were as follows: Therefore, the enterolith, bezoar, or food material within the PAD is frequently evacuated and thus, the symptom could be intermittent.
In relatively asymptomatic patients, non-surgical or conservative treatment is recommended. Lemmel syndrome is a rare condition that must be considered as a differential in cases of obstructive jaundice with no choledocholithiasis or tumour.
She had no chest pain, dyspnoea, cough or urinary symptoms. We diagnosed him as having Lemmel syndrome. Here, a case of Lemmel syndrome is presented. The remaining laboratory values were unremarkable. Contrast-enhanced axial A and coronal B CT lemmdl of the abdomen and pelvis two weeks after conservative treatment demonstrate a small duodenal diverticulum with significantly improved surrounding inflammatory changes arrows.
MRCP demonstrated mild distension of the gallbladder with several calculi. Amongst the different types of duodenal diverticula, periampullary duodenal diverticula are the most common [ 4 ]. Are you a health professional able to prescribe or dispense drugs?