Lemmel syndrome

Case contributed by Dr Vardan Abrahamyan
Diagnosis almost certain

Presentation

Jaundice, high levels of direct bilirubin.

Patient Data

Age: 60 years
Gender: Female
ct

Mildly dilated intrahepatic and extrahepatic biliary ducts (CBD - 1.0cm). In the biliary system, stones or mass aren't seen. At the 2nd part of the duodenum, there is seen an air-filled outpouching (periampullary diverticulum), that compresses the distal CBD. The gallbladder is removed.

Case Discussion

Duodenal diverticula are found in 27% of patients undergoing upper gastrointestinal examination. Periampullary diverticula (PAD) is the most common type. Although PAD does not usually provoke symptoms, it can be a source of obstructive jaundice even without choledocholithiasis or tumor.

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