Lemmel syndrome

Case contributed by Ammar Haouimi

Presentation

Obstructive jaundice. Past history of cholecystectomy 25 years ago.

Patient Data

Age: 90 years
Gender: Female
mri

Dilatation of the intra-and extrahepatic biliary ducts (CBD = 14 mm) as well as the pancreatic duct with a saccular thin-walled outpouching (30 mm) arising from the medial aspect of the second part of the duodenum (D2), compressing the duodenal papilla. A small non-obstructive stone is noted in the proximal CBD (8 mm).

Hiatal hernia.

Malrotated left kidney with bilateral parapelvic cysts.

Annotated image

Annotated image:

  • green arrow: duodenal diverticulum
  • yellow arrow: CBD
  • red arrow: pancreatic duct

Case Discussion

MRI features of a duodenal diverticulum compressing the duodenal papilla with dilatation of the intra-and extrahepatic biliary ducts as well as the pancreatic duct most consistent with Lemmel syndrome

Lemmel syndrome is defined as obstructive jaundice caused by a compressive periampullary duodenal diverticulum with resultant bile duct dilatation.

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