Lemmel syndrome as a complication of a duodenal diverticulum

Lemmel syndrome is a rare cause of obstructive jaundice due to mechanical compression of a periampullary diverticulum. They are usually asymptomatic, although complications such as cholangitis, diverticulitis, duodenal obstruction, hemorrhage, fistulas, perforation or pancreatitis may occur up to 5% of the time. They are diagnosed by ERCP and echoendoscopy. Conservative treatment is recommended in asymptomatic patients; therapeutic options include endoscopic sphincterotomy and surgery in recurrent cases.

A 74-year-old patient, cholecystectomized, was admitted to the Digestive Department for abdominal pain of 12 hours of evolution in the epigastrium and right hypochondrium accompanied by a fever of 38ºC. Laboratory tests showed an alteration of the hepatobiliary profile with a total bilirubin of 1.9 mg/dL, GOT/AST of 164 U/L and GPT/ALAT of 149 U/L. During admission, antibiotic treatment was started and an echoendoscopy was performed which showed dilatation of the biliary tract and the Wirsung without obstructive cause except for a large duodenal diverticulum of 30 mm, in the proximity of the major papilla. ERCP was performed (Figure 1) with sphincterotomy and immediate outflow of bile. Subsequently, after clinical and analytical improvement, he was discharged home.

Lemmel's syndrome, as a complication of duodenal diverticula, is a pathology that should be taken into account in a case of obstructive jaundice, in the absence of lithiasis and tumors of the pancreaticobiliary area that justify it. Echoendoscopy and ERCP are very useful for its diagnosis, as in the present case.

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Artikel online veröffentlicht:
27. März 2025