University of Utah School of Medicine Salt Lake City, UT, United States
Benjamin A. Hewitt, MD, Michael J. Sossenheimer, MD, PhD, FACG University of Utah School of Medicine, Salt Lake City, UT
Introduction: Lemmel Syndrome is a rare cause of obstructive jaundice in the absence of choledocholithiasis or other common etiologies of biliary obstruction. We present a case of a periampullary diverticulum causing compression of distal biliary tree.
Case Description/Methods: A 60-year-old female with no significant past medical history presented to the emergency department with one month of intermittent abdominal pain and back pain and one week of progressive nausea and anorexia. She was found to have elevated transaminases, markedly elevated alkaline phosphatase, and mild elevation in bilirubin. CT without oral contrast demonstrated intra- and extra-hepatic biliary dilation with concern for obstructing mass in the region of pancreatic head. Further characterization by MRCP suggested a duodenal diverticulum obstructing the distal common bile duct. ERCP was performed showing a large duodenal diverticulum, completely impacted with food. Careful snare and raptor extraction of the food impaction was successful resulting in resolution of patient’s symptoms and improvement of liver chemistries.
Discussion: Lemmel syndrome, first described in 1934, remains a rare cause of abdominal pain and biliary obstruction. Although not difficult to diagnose, recognition of this uncommon condition is paramount for timely management.
Figure: Figure 1 a) Duodenal diverticulum impacted with food bolus b) Diverticulum status post disimpaction c) Diverticulum encasing major papilla (arrow)
Benjamin Hewitt indicated no relevant financial relationships.
Michael Sossenheimer indicated no relevant financial relationships.
Benjamin A. Hewitt, MD, Michael J. Sossenheimer, MD, PhD, FACG. P2197 - Lemmel Syndrome: A Rare Cause of Biliary Obstruction, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.