Periampullary duodenal diverticulum causing obstructive jaundice: a case of Lemmel syndrome and review of the literature
Year: 2026
Type: article
Study design: Case Report
Abstract: Introduction: Lemmel syndrome is a rare cause of obstructive jaundice secondary to extrinsic compression of the distal common bile duct by a periampullary duodenal diverticulum. Its nonspecific clinical presentation often leads to misdiagnosis as choledocholithiasis or malignant obstruction. Case presentation: We report a 71-year-old man with no prior medical history who presented with a 2-month history of right upper quadrant pain, progressive jaundice, dark urine, fatigue, and weight loss. Laboratory tests revealed conjugated hyperbilirubinemia and elevated cholestatic enzymes. Abdominal ultrasound demonstrated bile duct dilation without intraluminal obstruction. Contrast-enhanced computed tomography revealed a well-defined periampullary duodenal diverticulum compressing the distal common bile duct, consistent with Lemmel syndrome. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and biliary stent placement, leading to clinical and biochemical improvement. Discussion: Lemmel syndrome should be suspected in elderly patients with obstructive jaundice when gallstones and malignancy are excluded. Cross-sectional imaging is essential for diagnosis, while ERCP offers both diagnostic and therapeutic benefits. Surgical intervention is reserved for endoscopic failure or complications. We reviewed all published cases of Lemmel syndrome over the past two decades, summarized in Table, to highlight current diagnostic and therapeutic trends. Conclusion: Awareness of Lemmel syndrome is essential to ensure timely diagnosis and appropriate management. Early identification and minimally invasive treatment can prevent severe complications and unnecessary surgery.
Institution: Tunis El Manar University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,090
OpenAlex ID: W7127563132