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Case Reports
. 2023 Jan 19;32(1):79-82.
doi: 10.4103/jmu.jmu_39_22. eCollection 2024 Jan-Mar.

Lemmel's Syndrome: Lesson Based on a Case Report

Renato Farina  1 , Pietro Valerio Foti  1 , Adriana Ilardi  1 , Antonio Basile  1
Affiliations
Case Reports

Lemmel's Syndrome: Lesson Based on a Case Report

Renato Farina et al. J Med Ultrasound. .

Abstract

Lemmel's syndrome is a bile duct disease caused by periampullary duodenal diverticula that develop within 2-3 cm of the Vater papilla. This disease manifests itself as nonobstructive jaundice. In most cases, duodenal diverticula do not cause disease, and only in a small percentage of patients, diverticula cause biliary tract obstruction by extrinsic compression. If the compression is severe, in the long term, it can become complicated with lithiasis and cholangitis. Diagnosis is very difficult, and recurrent biliary symptoms must be directly related to the compression of the duodenal diverticula. Imaging is essential for differential diagnosis and includes conventional contrast radiographs, endoscopic retrograde cholangiopancreatography, computed tomography, and magnetic resonance imaging. The investigations show the dilation of the intra- and extra-hepatic bile ducts in the absence of lithiasis or main pancreatic duct dilatation, compressed by the diverticula, which most frequently originate from the medial wall of the second duodenal tract. The treatment of choice is surgical with removal of the diverticula. Failure to diagnose can cause serious health complications for the patient.

Keywords: Biliary ducts; Lemmel’s syndrome; computed tomography; duodenum diverticula; resonance magnetic imaging; ultrasound.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Summary diagram of the anatomical structures involved in patients with LS. In LS, the PAD compresses the CBD. PV: Portal vein, GB: Gallbladder, CBD: Common bile duct, PAD: paravaterian diverticulum, LS: Lemmel syndrome
Figure 2
Figure 2
Ultrasound of the liver. (a): Ultrasound scans show no dilation of the right bile ducts; Hepatic veins (arrows) and (b) left bile ducts dilatation (arrows)
Figure 3
Figure 3
CT and MRI findings of LS. (a) MRI in coronal view shows PAD (arrow). (b) MRI-cholangiography shows left hepatic bile ducts dilatation (arrows head). PAD (long arrow). choledochus lithiasis (short arrow). (c) The CT in axial view shows a rounded image with an air/fluid level corresponding to the PAD (arrow). (d) CT in axial view shows left bile ducts dilation (short arrows). Biliary cyst (long arrow). CT: Computed tomography, MRI: Magnetic resonance imaging, LS: Lemmel’s syndrome, PAD: Paravaterian diverticulum
See this image and copyright information in PMC

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