JUST BECAUSE IT IS RARE DOESN’T MEAN IT IS IMPLAUSIBLE: LEMMEL’S SYNDROME A CASE SERIES

Lemmel’s syndrome is a rare pancreaticobiliary complication of duodenal diverticula. It occurs when a duodenal diverticulum causes obstructive jaundice due to a mechanical obstruction of the common bile duct. Other mechanisms like sphincter of Oddi dysfunction can also play a role in pathophysiology. We report three cases of Lemmel’s syndrome where liver biochemistry showed obstructive jaundice; but subsequent MRCP showed a massive periampullary diverticulum causing biliary obstruction. Early detection and intervention can prevent needless additional investigations and complications due to obstruction.

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An Unusual Cause of Biliary Tract Obstruction: Lemmel Syndrome

Clinical Medicine Insights Case Reports ◽

10.1177/11795476211063321 ◽

2021 ◽

Vol 14 ◽

pp. 117954762110633

Author(s):

Benayad Aourarh ◽

Mouna Tamzaourte ◽

Ahlame Benhamdane ◽

Sanaa Berrag ◽

Tarik Adioui ◽

...

Keyword(s):

Obstructive Jaundice ◽

Duodenal Diverticulum ◽

Mechanical Obstruction ◽

Line Treatment ◽

First Line ◽

Case Presentation ◽

Ascending Cholangitis ◽

Lemmel’S Syndrome ◽

The Common ◽

First Line Treatment

Background: Lemmel syndrome is a rare and misdiagnosed etiology of obstructive jaundice due to a periampullary duodenal diverticulum causing a mechanical obstruction of the common bile duct. It represents an obstructive jaundice with the absence of choledocholithiasis or pancreaticobiliary tumors. It is an underreported entity due to the absence of specific pathognomonic signs. Case presentation: A 77-year-old-woman admitted for sepsis, due to an ascending cholangitis, underwent a MRCP and a gastroduodenoscopy revealing Lemmel’s syndrome. Due to failure of ERCP, the patient underwent surgical derivation. Conclusion: Lemmel syndrome represents an uncommon diagnosis of obstructive jaundice, that shouldn’t be neglected if no other organic cause is detected. It is usually asymptomatic, however some patients can develop symptoms and complications such as cholangitis, as is the case of our patient. Imaging allows diagnosis, with MRCP as the modality of choice to confirm diagnosis. Endoscopy is the first line treatment.

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Gall bladder disease

10.1093/med/9780199568741.003.0200 ◽

2018 ◽

Author(s):

Satish Keshav ◽

Alexandra Kent

Keyword(s):

Gall Bladder ◽

Gall Bladder Disease ◽

Sphincter Of Oddi ◽

Biliary Tree ◽

Primary Biliary Cholangitis ◽

Sphincter Of Oddi Dysfunction ◽

Biliary Disease ◽

Bladder Polyps ◽

The Common ◽

Oddi Dysfunction

The gall bladder is a sac which lies underneath the liver and stores and concentrates bile produced by the liver. As food enters the duodenum, it stimulates the release of cholecystokinin, which in turn stimulates the release of bile, which passes via the cystic duct to the common bile duct, which connects to the duodenum at the sphincter of Oddi. Bile is required in digestion, especially for the emulsification and absorption of fat. Biliary disease can take several forms. Cholelithiasis refers to the presence of gallstones in the gall bladder, whereas choledocholithiasis refers to gallstones in the biliary tree. Cholecystitis is inflammation and infection of the gall bladder. Cholangitis is inflammation and infection of the biliary tree. Sphincter of Oddi dysfunction (SOD) is characterized by symptoms of biliary obstruction, with no structural cause. Other forms of biliary disease are gall bladder polyps, primary biliary cholangitis, and primary sclerosing cholangitis.

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An unusual cause of obstructive jaundice: Lemmel’s syndrome

BJR|case reports ◽

10.1259/bjrcr.20200166 ◽

2020 ◽

pp. 20200166

Author(s):

Habib Bellamlih ◽

Meryem Echchikhi ◽

Aymane El Farouki ◽

Nabil Moatassim Billah ◽

Ittimade Nassar

Keyword(s):

Obstructive Jaundice ◽

Bile Ducts ◽

Case Reports ◽

Rare Condition ◽

Duodenal Diverticulum ◽

Hepatic Bile ◽

Compression Effect ◽

Good Improvement ◽

Lemmel’S Syndrome ◽

The Common

Lemmel’s syndrome is a rare and misdiagnosed cause of obstructive jaundice. The cause of the obstacle is a duodenal diverticulum located at the periampullary generating a compression effect on the common bile duct with secondary dilation of the extra- and intra-hepatic bile ducts. Late diagnosis of this entity is common and may lead to unnecessary further investigations and therapeutic delay. There are only few case reports of this rare condition. We report a case of 77-year-old female presenting with obstructive jaundice due to Lemmel’s syndrome. The diagnosis was made on a set of clinical, biological and radiological arguments with good improvement after medical treatment.

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Biliary type-II sphincter of Oddi dysfunction with a pancreatic duct dilation: a case report and review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-02674-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Naseem Al-Khoury ◽

Okbah Mohamad ◽

Abd Al-Jawad Mazloum ◽

Maher Madi

Keyword(s):

Pancreatic Duct ◽

Sphincter Of Oddi ◽

Sphincter Of Oddi Dysfunction ◽

Type Ii ◽

Case Presentation ◽

Pancreatic Malignancy ◽

The Common ◽

Oddi Dysfunction ◽

Epigastric Abdominal Pain

Abstract Background The double-duct sign is defined as dilation of both the common bile duct and pancreatic duct, which usually indicates pancreatic malignancy. However, benign causes have also been reported to cause a double-duct sign. Case presentation We present the case of a 59-year-old Caucasian female patient admitted to the Gastroenterology Department with intermittent right epigastric abdominal pain and an intact gallbladder. A double-duct sign was seen on endoscopic ultrasound. The suspicion of pancreatic malignancy was excluded through follow-up investigations. Biliary type II sphincter of Oddi dysfunction was diagnosed with an association of the double-duct sign. Sphincterotomy was performed to reduce pain, and there was no recurrence of symptoms during follow-up. Conclusions This is the third reported case in the literature of the double-duct sign associated with sphincter of Oddi dysfunction. This case emphasizes that the double-duct sign is not always caused by a local malignancy. The literature review of the reported cases has been summarized to help in the diagnosis of future similar cases.

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