An Unusual Case of Painless Obstructive Jaundice and Cholangitis: Lemmel’s Syndrome- A Case Report

Praveen S Padasali,Vinayak Thakkannavar

doi:10.5530/ogh.2018.7.2.25

Abstract

An Unusual Case of Painless Obstructive Jaundice and Cholangitis: Lemmel’s Syndrome- A Case Report

Highlights

Lemmels syndrome is obstructive jaundice caused by a periampullary duodenal diverticula causing extrinsic compression of common bile duct (CBD).[1]
Periampullary diverticula (PAD) refer to extraluminal outpouchings of duodenal mucosa that develop within the radius of 2 to 3 cm from the ampulla of Vater.[2]
We experienced an unusual case of painless obstructive jaundice and cholangitis due to extrinsic compression of distal common bile duct (CBD) by inflammed PAD

Summary

INTRODUCTION

Lemmels syndrome is obstructive jaundice caused by a periampullary duodenal diverticula causing extrinsic compression of CBD.[1]. On MRCP reconstructed images, the there was PAD compressing the distal bile duct and signs of diverticulum (Figure 1) (Figure 2) (Figure 3) These findings were confirmed on upper gastrointestinal endoscopy which shows periampullary diverticulum and signs of diverticula erythema and inflammation and normal appearing ampulla of vater, After confirming with endoscopy, the patient was kept nil by mouth for few days and put on medical treatment with intravenous metronidazole and imipenem and shows good results and cholangitis resolution as her fever subsided within 2-3 days and her blood count was returning to normal and liver enzyme was normalized. When the patient visited the outpatient clinic for follow up her repeat liver enzymes shows normal reports and repeat endoscopy for follow up study shows normal mucosa in PAD. She remains clinically and endoscopically disease free after the last admission

Findings

DISCUSSION

CONCLUSION