J Korean Med Sci.  2014 Jun;29(6):874-878. 10.3346/jkms.2014.29.6.874.

Lemmel's Syndrome, an Unusual Cause of Abdominal Pain and Jaundice by Impacted Intradiverticular Enterolith: Case Report

• Kang HS
• Hyun JJ
• Kim SY
• Jung SW
• Koo JS
• Yim HJ
• Lee SW

• KMID: 1796954
• DOI: http://doi.org/10.3346/jkms.2014.29.6.874

Abstract

Duodenal diverticula are detected in up to 27% of patients undergoing upper gastrointestinal tract evaluation with periampullary diverticula (PAD) being the most common type. Although PAD usually do not cause symptoms, it can serve as a source of obstructive jaundice even when choledocholithiasis or tumor is not present. This duodenal diverticulum obstructive jaundice syndrome is called Lemmel's syndrome. An 81-yr-old woman came to the emergency room with obstructive jaundice and cholangitis. Abdominal CT scan revealed stony opacity on distal CBD with CBD dilatation. ERCP was performed to remove the stone. However, the stone was not located in the CBD but rather inside the PAD. After removal of the enterolith within the PAD, all her symptoms resolved. Recognition of this condition is important since misdiagnosis could lead to mismanagement and therapeutic delay. Lemmel's syndrome should always be included as one of the differential diagnosis of obstructive jaundice when PAD are present.

Keyword

Enterolith; Lemmel's Syndrome; Periampullary Diverticulitis

MeSH Terms

Abdominal Pain
Aged, 80 and over
Cholangiopancreatography, Endoscopic Retrograde
Cholangiopancreatography, Magnetic Resonance
Cholangitis/complications
Diverticulum
Duodenal Diseases/complications/*diagnosis
Female
Fluoroscopy
Gallstones/diagnosis/therapy
Humans
Jaundice, Obstructive/*complications
Tomography, X-Ray Computed