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Case Reports
. 2017 Mar 1;9(3):e1066.
doi: 10.7759/cureus.1066.

Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

Keyur Desai  1 , Joshua D Wermers  2 , Nebiyu Beteselassie  1
Affiliations
Case Reports

Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report

Keyur Desai et al. Cureus. .

Abstract

Lemmel syndrome occurs when a duodenal diverticulum causes obstructive jaundice due to a mechanical obstruction of the common bile duct. Additional pathophysiologic processes may also contribute to the development of Lemmel syndrome. These include duodenal diverticula causing dysfunction of the sphincter of Oddi as well as compression of the common bile duct by duodenal diverticula. It is uncommon for duodenal diverticulum to become inflamed. We report the case of a 25-year-old female presenting with unintentional weight loss and fatigue. Since her initial labs were concerning for possible infection with hepatobiliary abnormalities, a contrast-enhanced CT was obtained. This study revealed a large periampullary diverticulum with mucosal enhancement and fat stranding consistent with diverticulitis.

Keywords: ct; duodenal diverticulitis; duodenal diverticulum; lemmel syndrome; mrcp.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Contrast-enhanced Axial CT of the Upper Abdomen (Pre-Treatment)
Contrast-enhanced axial CT images of the upper abdomen demonstrate (A) a periampullary duodenal diverticulum with surrounding inflammatory changes consistent with diverticulitis, including wall thickening and fat stranding (arrow). (B) An axial slice slightly more cephalad shows dilated intrahepatic bile ducts (open arrow). Also seen are the stomach and proximal duodenum, which are dilated with air-fluid levels (arrowheads).
Figure 2
Figure 2. Contrast-enhanced Coronal and Sagittal CT of the Abdomen and Pelvis (Pre-Treatment)
Contrast-enhanced reformatted images of the abdomen and pelvis demonstrate (A) an inflamed periampullary diverticulum, which obstructs the common bile duct (arrow). The common bile duct (open arrow) is significantly dilated. In addition, intrahepatic biliary ductal dilation is seen. (B) The sagittal image provides another view of the duodenal diverticulitis and common bile duct dilation (arrows).
Figure 3
Figure 3. T2-weighted Coronal MRI of the Abdomen (Pre-Treatment)
T2-weighted coronal MR images of the abdomen re-demonstrate (A) a periampullary duodenal diverticulum with surrounding inflammatory changes (arrow).  (B) A more posterior slice demonstrates a dilated common bile duct and proximal intrahepatic ducts (open arrow).
Figure 4
Figure 4. Contrast-enhanced Axial (A) and Coronal (B) CT Images of the Abdomen and Pelvis (Post-Treatment)
Contrast-enhanced axial (A) and coronal (B) CT images of the abdomen and pelvis two weeks after conservative treatment demonstrate a small duodenal diverticulum with significantly improved surrounding inflammatory changes (arrows). Intrahepatic biliary ductal dilation is significantly improved (open arrow).
See this image and copyright information in PMC

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