Presentation
The patient presented with vague abdominal pain for two days.
Patient Data
A doudenal diverticulum seen arising from the first part of doudenum with internal air-fluid levelling, along with dilated CBD, hepatic and cystic ducts and mild intrahepatic biliary tree dilation.
The gallbladder appears distended with pericholecystic edema without internal dense stone.
The right kidney appears small in size with thinning of its artery.
Ectatic abdominal aorta with multiple calcified and non calcified atheromatous plaques noted over the visualized vessels.
Few left renal cortical fluid density lesions.
MRCP confirms the previously mentioned CT scan findings, showing the first part duodenal diverticulum measuring about 1 x 1.4 x 1.6 cm seen anterior to distal CBD causing mass effect on it leading to CBD, pancreatic duct, and intra-hepatic biliary tree dilation with an abrupt change in CBD caliber just near the abovementioned diverticulum.
The CBD reaches a maximum diameter of about 1.1 cm and the pancreatic duct reaches about 4.4 mm.
Distended gallbladder abutting the first part of the duodenum with pericystic edema and medial insertion of the cystic duct.
Overall features may suggest Lemmel syndrome.
Case Discussion
Lemmel syndrome is an obstructive disease of the biliary tree caused by and external compression from an out pouching (diverticulum) usually arising from the second part of doudenum.
Various presentations can be seen, such as jaundice, pancreatitis and cholangitis.
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