JUST BECAUSE IT IS RARE DOESN’T MEAN IT IS IMPLAUSIBLE: LEMMEL’S SYNDROME A CASE SERIES

Lemmel’s syndrome is a rare pancreaticobiliary complication of duodenal diverticula. It occurs when a duodenal diverticulum causes obstructive jaundice due to a mechanical obstruction of the common bile duct. Other mechanisms like sphincter of Oddi dysfunction can also play a role in pathophysiology. We report three cases of Lemmel’s syndrome where liver biochemistry showed obstructive jaundice; but subsequent MRCP showed a massive periampullary diverticulum causing biliary obstruction. Early detection and intervention can prevent needless additional investigations and complications due to obstruction.

An Unusual Cause of Biliary Tract Obstruction: Lemmel Syndrome

Background: Lemmel syndrome is a rare and misdiagnosed etiology of obstructive jaundice due to a periampullary duodenal diverticulum causing a mechanical obstruction of the common bile duct. It represents an obstructive jaundice with the absence of choledocholithiasis or pancreaticobiliary tumors. It is an underreported entity due to the absence of specific pathognomonic signs. Case presentation: A 77-year-old-woman admitted for sepsis, due to an ascending cholangitis, underwent a MRCP and a gastroduodenoscopy revealing Lemmel’s syndrome. Due to failure of ERCP, the patient underwent surgical derivation. Conclusion: Lemmel syndrome represents an uncommon diagnosis of obstructive jaundice, that shouldn’t be neglected if no other organic cause is detected. It is usually asymptomatic, however some patients can develop symptoms and complications such as cholangitis, as is the case of our patient. Imaging allows diagnosis, with MRCP as the modality of choice to confirm diagnosis. Endoscopy is the first line treatment.