Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Oct 4;16(12):3783-3786.
doi: 10.1016/j.radcr.2021.08.068. eCollection 2021 Dec.

Lemmel's syndrome due to giant periampullary diverticulum: report of a case

Alessio Volpe  1 , Chiara Risi  1 , Maurizio Erra  1 , Annamaria Cioffi  1 , Vincenzo Casella  1 , Giacomo Fenza  1
Affiliations
Case Reports

Lemmel's syndrome due to giant periampullary diverticulum: report of a case

Alessio Volpe et al. Radiol Case Rep. .

Abstract

Lemmel's syndrome is a rare cause of obstructive jaundice in the absence of stones or tumors, commonly due to periampullary duodenal diverticulum (PAD). CT scan with the oral and intravenous administration of iodinated contrast media, was crucial to exclude the presence of stones or tumours, but esophagogastroduodenoscopy (EGD) confirms the diagnosis. We report a case of a 72 -year-old woman affected by Lemmel's syndrome secondary to a giant PAD, suffering from right upper abdominal quadrant pain and pancreaticobiliary disease. Subsequently we proceed to analyse the pathogenesis of PAD, and later to discuss pitfalls, tips and tricks useful to make a correct diagnosis, in order to achieve an accurate management.

Keywords: Cholangitis; Lemmel's syndrome; Pancreaticobiliary disease; Pancreatitis; Periampullary duodenal diverticulum.

PubMed Disclaimer

Figures

Fig 1
Fig. 1
Abdominal US. Hypo-anechoic, rounded, 4 cm mass (green arrow) with multiple hyperechoic spots inside; gallbladder on the right of the PAD (red arrow) (Color version of figure is available online)
Fig 2
Fig. 2
NECT (A-B) and CECT with oral contrast administration (C-D). 4 cm PAD filled by food (green arrow). Oral contrast (C-D) was administrated to better identify diverticulum. Coronal reconstructions (B-D) show the bile duct dilatation (red arrow) due to extrinsic compression of PAD (green arrow) (Color version of figure is available online)
Fig 3
Fig. 3
Three-dimensional CT reconstruction with volume rendering (3D-VR), after oral contrast administration, shows PAD (green arrow) (Color version of figure is available online)
Fig 4
Fig. 4
EGDS. Images show the large PAD (green arrow) in the second portion of the duodenum (red arrow) (Color version of figure is available online)
See this image and copyright information in PMC

References

    1. Bernshteyn M, Rao S, Sharma A, Masood U, Manocha D. Lemmel's syndrome: usual presentation of an unusual diagnosis. cureus. 2020;12(4):e7698. doi:10.7759/cureus.7698. - DOI - PMC - PubMed
    1. Vitturi N, Simoni F, De Stefano F, Orlando R, Lirussi F, Realdi G. Paravaterian diverticula presenting as acute cholangitis in two very elderly patients. J Gastrointestin Liver Dis. 2010;19(2):220–221. - PubMed
    1. Pimparkar BD. In: Gastroenterology. 3rd (Ed) Bockus Henry L, editor. WB Saunders Co; Philadelphia: 1976. Diverticulosis of the small intestine In; pp. 437–458. (Ed)
    1. Cheshire NJ, Diverticula Glezer G. In: Maingoats Abdominal operation. 10th (Ed) Zinner MJ, Schwartz SI, Ellis H, editors. Prentice Hall International Ince (UK) Limited; London: 2021. volvulus, superior mesenteric artery syndrome and foreign bodies. In. (Ed) 916-2.
    1. Mahajan Sanjay, Rajesh Kashyap, K Chandel, Mokta Jatinder, S Minhas. (2004). Duodenal diverticulum: Review of literature. Ind J Surge. 2004;66:140–145. Num 366.

Publication types

LinkOut - more resources