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INTERMITTENT OBSTRUCTIVE JAUNDICE DUE TO A DUODENAL DIVERTICULUM: LEMMEL’S SYNDROME INITIALLY MISSED ON CT BUT LATER EVINCED WITH MAGNETIC RESONANCE CHOLANGIOGRAPHY AND ENDOSCOPY

Leslie-Marisol Gonzalez-Hermosillo1, Jose-Gustavo Reyes-Rodriguez2, Gustavo Reyes-Rodriguez3, Fatima Palacio-Lopez4, Maria-del-Carmen Garcia-Blanco1, Gerardo Blanco-Velasco5, Enrique Rojas-Herrera4, Ernesto Roldan-Valadez6, 7

Due to a mechanical obstruction of the common bile duct, Lemmel’s syndrome arises when a duodenal diverticulum induces obstructive jaundice. Intermittent obstructive jaundice is a rare conditionreported in 2-7% of patients undergoing studies. Although the majority of the diverticula are asymptomatic when the symptoms are present, they usually consist of jaundice, abdominal pain, or acute cholangitis; these symptoms can be intermittent. The imaging methods in diagnosing Lemmel’s syndrome are crucial; the CT scan and magnetic resonance cholangiography (MRC) revealed periampullary diverticula on the medial wall of the second portion of the duodenum. Treatment varies depending on the aetiology and underlying cause. However, diverticulectomy remains the standard of care.

This report describes a 75-year-old male who attended the emergency department with jaundice, acute abdominal pain, and a weight loss history. Through laboratory studies and duodenal endoscopy, obstructive jaundice due to Lemmel’s syndrome was evinced and received appropriate treatment. Lemmel’s syndrome was initially missed in the CT evaluation but identified in the MRC and endoscopic view of duodenal endoscopy. Clinicians should always consider diverticulum as a possible cause of pancreatitis and obstructive jaundice. Readers will find an updated review of the literature.

1 - Directorate of Research, Hospital General de México “Dr Eduardo Liceaga”. Mexico City, Mexico.

2 - Faculty of Medicine, National Autonomous University of Mexico. Mexico City, Mexico.

3 - Department of Surgery, Laparoscopy and Robotics.Hospital Angeles Acoxpa.Mexico City, Mexico.

4 - Department of Radiology, Hospital Angeles Acoxpa. Mexico City, Mexico.

5 - Hospital de Especialidades, CMN sXXI IMSS. Mexico City, Mexico.

6 - Directorate of Research, Hospital General de Mexico “Dr Eduardo Liceaga”. Mexico City, Mexico.

7 - I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology. Moscow, Russia.

 

Keywords: Lemmel’s syndrome; obstructive jaundice; magnetic resonance cholangiography; endoscopy.

 


Corresponding author: Gustavo Reyes-Rodriguez, e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript ; Ernesto Roldan-Valadez, e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Leslie-Marisol Gonzalez-Hermosillo, Jose-Gustavo Reyes-Rodriguez, Gustavo Reyes-Rodriguez, Fatima Palacio-Lopez, Maria-del-Carmen Garcia-Blanco, Gerardo Blanco-Velasco, Enrique Rojas-Herrera, Ernesto Roldan-Valadez Intermittent obstructive jaundice due to a duodenal diverticulum: Lemmel’s syndrome initially missed on CT but later evinced with magnetic resonance cholangiography and endoscopy. REJR 2021; 11(3):198-203. DOI: 10.21569/2222-7415-2021-11-3-198-203.

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Received:        26.06.21 Accepted:       30.08.21