Presentation
Obstructive jaundice. Past history of cholecystectomy 25 years ago.
Patient Data
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:
- 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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