Post Traumatic Lemmel's Syndrome: A Rarest of Rare Cause of Obstructive Jaundice

Abstract

Obstructive jaundice caused by periampullary duodenal diverticulum in absence of choledocholithiasis or tumor is known as Lemmel syndrome. This is a rare cause of obstructive jaundice. We report here a patient of blunt trauma abdomen who underwent emergency laparotomy whose sequelae was a controlled external biliary fistula which healed and led to obstructive jaundice. What appeared to be a clear cut diagnosis of benign biliary stricture or bilioma gave a surgical surprise on opening the pandoras box. The uniqueness of this case lies in its etiopathogenesis as well as the dearth of available literature related to post traumatic Lemmel syndrome. This case provides us with a insight into an easy to be overlooked cause of obstructive jaundice in the absence of duodenal diverticula.

Keywords: lemmel’s syndrome; post traumatic lemmel’s syndrome; post traumatic obstructive jaundice.

Figure 1. Focal out pouching of the duodenum causing compression of common bile duct. A: coronal cut. B: axial cut.

Figure 2. The expected and the unexpected. (A) shows what we were anticipating, an extrinsic diverticulum compressing the common bile duct. (B) shows the intraoperative finding. (Freehand illustration of the intraoperative finding.)