Lemmel syndrome

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

History of recurrent episodes of jaundice with right upper quadrant pain.

Patient Data

Age: 95 years
Gender: Female
ct
This study is a stack
Axial C+ portal
venous phase
This study is a stack
Coronal C+ portal
venous phase
This study is a stack
Sagittal C+ portal
venous phase
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Info

Focal outpouching with a thin wall arising from the medial aspect of the second part of the duodenum (D2), adjacent to the papilla measuring 35 mm, compressing the distal CBD with no wall defect or adjacent fluid or gas collection. The proximal CBD measures 11 mm with mild dilatation of the intrahepatic biliary ducts. Small gallstones are noted, confirmed by ultrasound (not shown).

A simple cortical left renal cyst is noted (5 cm).

Case Discussion

CT features of a duodenal diverticulum arising from the medial aspect of the second part of the duodenum compressing the distal CBD most consistent with Lemmel syndrome

Lemmel syndrome is defined as obstructive jaundice caused by a periampullary duodenal diverticulum compressing the intrapancreatic common bile duct with resultant bile duct dilatation.

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