Post Traumatic Lemmel's Syndrome: A Rarest of Rare Cause of Obstructive Jaundice.

Kunal Parasar,Shantam Mohan,Utpal Anand,Aaron G John

doi:10.7759/cureus.9862

Kunal Parasar, Shantam Mohan + Show 2 more

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https://doi.org/10.7759/cureus.9862

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Journal: Cureus	Publication Date: Aug 19, 2020
Citations: 2	License type: cc-by

Affiliation: All India Institute of Medical Sciences

Abstract

Obstructive jaundice caused by periampullary duodenal diverticulum in absence of choledocholithiasis or tumor is known as Lemmel syndrome. This is a rare cause of obstructive jaundice. We report here a patient of blunt trauma abdomen who underwent emergency laparotomy whose sequelae was a controlled external biliary fistula which healed and led to obstructive jaundice. What appeared to be a clear cut diagnosis of benign biliary stricture or bilioma gave a surgical surprise on opening the pandoras box. The uniqueness of this case lies in its etiopathogenesis as well as the dearth of available literature related to post traumatic Lemmel syndrome. This case provides us with a insight into an easy to be overlooked cause of obstructive jaundice in the absence of duodenal diverticula.

Highlights

Obstructive jaundice is a common presentation in surgical wards with choledocholithiasis and hepatobiliary malignancies being the most common causes
Obstructive jaundice caused by periampullary duodenal diverticulum in absence of choledocholithiasis or tumor is known as Lemmel syndrome
We report here a patient of blunt trauma abdomen who underwent emergency laparotomy whose sequelae was a controlled external biliary fistula which healed and led to obstructive jaundice

Summary

Introduction

Obstructive jaundice is a common presentation in surgical wards with choledocholithiasis and hepatobiliary malignancies being the most common causes. We present a case of a rare cause of obstructive jaundice in its rarest presentation. A 21-year-old, healthy male patient was admitted in a peripheral center with blunt trauma to the abdomen. He presented with tachycardia and abdominal distension. In the post-operative period, he continued to have significant drain output (≈ 600 ml) per day which was bilious in nature and was referred to our center. Contrast enhancing CT scan showed a 3x3 cm heterogenous cystic lesion compressing the supraduodenal part of common bile duct (CBD) with nonvisualized distal duct associated with the presence of debris inside the cyst (Figure 1). How to cite this article Parasar K, John A G, Mohan S, et al (August 19, 2020) Post Traumatic Lemmel’s Syndrome: A Rarest of Rare Cause of Obstructive Jaundice. It has been reported very rarely in literature and post traumatic Lemmel’s syndrome has never been reported

Discussion

Conclusions

Disclosures

Medina Andrade L