Lemmel Syndrome: A Rare Cause of Right Hypochondrial Pain Secondary to Duodenal Diverticulum
Nikita Rolekar and Sidharth Misra*
Department of General Surgery, Terna Specialty Hospital and Research Centre, India
*Corresponding Author: Sidharth Misra, Department of General Surgery, Terna Specialty Hospital and Research Centre, India.
Received: January 09, 2023;
Published: February 02, 2023
Although, it is a reflex to link right hypochondrial pain and obstructive jaundice to choledocholithiasis, there are many rare causes out of which Lemmel syndrome is one of them. It occurs when a duodenal diverticulum causes mechanical obstruction of the common bile duct. Imaging modalities play a vital role in the diagnosis as it can be easily misdiagnosed. We report the case of a 55-year-old male presenting with right hypochondrial pain and loss of appetite. On physical examination, there was tenderness in the right upper quadrant. Initial blood investigations revealed an elevated total leukocyte count with a neutrophilic predominance and an elevated liver function test. A contrast enhanced CT was ordered that revealed two duodenal diverticula causing mass effect on the distal CBD and the pancreatic duct. Subsequently, the patient was managed conservatively that led to a significant decline in the signs and symptoms.
Keywords: Lemmel Syndrome; Obstructive Jaundice; Duodenal Diverticulum; Right Hypochondrial Pain
- Bernshteyn M., et al. “Lemmel’s Syndrome: Usual Presentation of an Unusual Diagnosis”. Cureus 4 (2020): e7698.
- Azzam A Z., et al. “Lemmel Syndrome as a Rare Cause of Prolonged Right Hypochondrial Pain: A Case Report”. Cureus 12 (2021): e20093.
- Agúndez MC., et al. “Síndrome de Lemmel: ictericia obstructiva secundaria a divertículo duodenal”. Cirugía Española 95 (2017): 550-551.
- T Zoepf., et al. “The relationship between juxtapapillary duodenal diverticula and disorders of the biliopancreatic system: analysis of 350 patients”. Gastrointestinal Endoscopy 54 (2001): 56-61.
- Desai K., et al. “Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report”. Cureus 3 (2017): e1066.
- Yanagaki M., et al. “Erratum”. International Journal of Surgery Case Reports 72 (2020): 560-563.
- Lemmel G. “Die Klinische Bedeutung der Duodenal Divertikel”. Arch Verdauungskrht 46 (1934): 59-70.
- Gore RM., et al. “Diverticulitis of the duodenum: clinical and radiological manifestations of seven cases”. American Journal of Gastroenterology 86 (1991): 981-985.
- Figueroa-Rivera Ivonne MD., et al. “Lemmel's Syndrome: A Rare Phenomenon Causing Obstructive Jaundice”. American Journal of Gastroenterology 112 (2017): S722-S723.
- Ono M., et al. “MRCP and ERCP in Lemmel syndrome”. JOP 6 (2005): 277-278.
- Lobo DN., et al. “Periampullary diverticula and pancreaticobiliary disease”. British Journal of Surgery 86 (1999): 588-597.
- Wu SD., et al. “Relationship between intraduodenal peri-ampullary diverticulum and biliary disease in 178 patients undergoing ERCP”. Hepatobiliary and Pancreatic Diseases International: HBPD INT 6 (2007): 299-302.
- Gudjonsson H., et al. “Symptomatic biliary obstruction associated with juxtapapillary duodenal diverticulum”. Digestive Diseases and Sciences 33 (1988): 114-121.
- Egawa N., et al. “Juxtapapillary duodenal diverticula and pancreatobiliary disease”. Digestive Surgery 27 (2010): 105-109.
- San Román AL., et al. “Direct compression by a duodenal diverticulum causing common bile duct obstruction”. Endoscopy 26 (1994): 334.
- Castilho Netto JM., et al. “Ampullary duodenal diverticulum and cholangitis”. São Paulo Medical Journal 121 (2003): 173-175.
- Rouet J., et al. “Lemmel's syndrome as a rare cause of obstructive jaundice”. Clinics and Research in Hepatology and Gastroenterology 36 (2012): 628-631.
- E Thomas and KR Reddy. “Cholangitis and pancreatitis due to juxtapapillary duodenal diverticulum. Endoscopic sphincterotomy is the other alternative in selected cases”. American Journal of Gastroenterology 77 (1982): 303-304.
- Frauenfelder G., et al. “Computed tomography imaging in lemmel syndrome: a report of two cases”. The Journal of Clinical Imaging Science 9 (2019): 1-4.
- Perdikakis E., et al. “Diagnosis of periampullary duodenal diverticula: the value of new imaging techniques”. Annals of Gastroenterology3 (2011): 192-199.
- Tobin R., et al. “A giant duodenal diverticulum causing Lemmel syndrome”. Journal of Surgical Case Reports 10 (2018): 263.