E1035. Lemmel Syndrome: Different Forms of Presentation
Authors
Marina Bustamante;
Hospital Universitario CEMIC
Victor Polanco;
Hospital Universitario CEMIC
Nebil Larrañaga ;
Hospital Universitario CEMIC
Kozima Shigeru;
Hospital Universitario CEMIC
German Espil ;
Hospital Universitario CEMIC
Paula Perroni;
Hospital Universitario CEMIC
Background
To review the different forms of presentation of Lemmel syndrome, describing the main findings visualized in multidetector computed tomography (MDCT).
Educational Goals / Teaching Points
Lemmel syndrome is defined as obstructive jaundice secondary to compression of the intrapancreatic portion of the common bile duct by a periampullary duodenal diverticulum, with the resulting dilatation of the extrahepatic and intrahepatic bile ducts.
In the present work we will make an anatomical review of the periampullary region and the most common forms of presentation of Lemmel's syndrome, mentioning among them: acute bacterial cholangitis, diverticulitis and pancreatitis.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The diagnosis of Lemmel syndrome can be made with confidence by direct visualization on endoscopic retrograde cholangiopancreatography (ERCP) using a side-view endoscope. However, MDCT with its multiplanar capability, can indicate the diagnosis noninvasively and, at the same time, allows exclusion of other periampullary diseases.
Conclusion
Lemmel syndrome is a rare cause of obstructive jaundice and should be included in the differential diagnosis of pathologies that produce biliary obstruction. Clinical symptoms suggestive of repeated cholangitis or pancreatitis together with MDCT imaging findings play a fundamental role in determining the location of the disease, as well as the severity of the associated complications, being important both for the diagnosis and for the therapeutic planning of the pathology.
