Presentation
Right subcostal abdominal pain and obstructive jaundice.
Patient Data
Dilatation of central intrahepatic and extrahepatic biliary ducts (CHD:10 mm and CBD:9 mm), as well as pancreatic duct (3.5 mm).
Large air-filled outpouching measuring about 20*40 mm at the second part of the duodenum mesenteric border exerts pressure on the distal end of the CBD pancreatic segment and the common duct.
Thickening of the gallbladder wall (6mm), contains a hypodense layer of subserosal edema that mimics pericholecystic fluid with an internal 20 mm hyperdense stone.
Ptotic and malrotation of the left kidney.
Spine degenerative changes as multilevel endplate sclerosis and marginal osteophyte formation are seen.
Case Discussion
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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