Lemmel syndrome

Case contributed by Dr Ali Alsmair

Presentation

Patient presented with jaundice and upper abdominal pain .

Patient Data

Age: 75 years
Gender: Female
MRI

There is a well-defined lesion that seems to arise from the medial wall of second part of duodenum, it contains foci of flow void (air locules). It causes a mass effect on the distal C.B.D and distal pancreatic duct, resulting in dilatation of proximal C.B.D (12mm), pancreatic duct (6.5 mm) and intrahepatic biliary tree.

This lesion measures about 3.6x3.9x3.6 cm (AP,transverse,CC).

Features are in keeping with duodenal diverticulum arising from the medial aspect of second part of duodenum resulting in biliary tree obstruction (Lemmel syndrome).

Multiple small gall stones are also noted.

CT

There is a diverticulum arising from the medial aspect of the 2nd part of duodenum, causing dilatation of pancreatic duct and C.B.D, giving double duct sign.

Multiple small gall stones are also noted.

Tiny left renal lower calyceal gravel.

Case Discussion

Lemmel syndrome is a rare cause of obstructive jaundice, as in this case, it may compress pancreatic duct giving double duct appearance.

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