Khan Babar Ahmad, Khan Sania Hanif, Sharma Anuj
Department Of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
Eur J Case Rep Intern Med. 2017 May 5;4(6):000632. doi: 10.12890/2017_000632. eCollection 2017.
In 1934 Lemmel was the first to report the presence of juxtapapillary diverticula and hepatocholangiopancreatic disease, excluding cholelithiasis. Obstructive jaundice caused by periampullary duodenal diverticulum (PAD) in absence of choledocholithiasis or tumor is known as Lemmel syndrome. A patient with an extraluminal duodenal diverticulum presenting with obstructive jaundice and pancreatitis is presented in this case. Although initially managed conservatively, the patient had recurrence of symptoms after 2 months but then had successful surgical resection of the duodenal diverticulum.
Lemmel's syndrome should be considered in patients with pancreaticobiliary disease in the absence of tumors, stricture, or cholelithiasis.Non-invasive imaging studies should be considered first but endoscopic retrograde cholangiopancreatography (ERCP) remains the diagnostic method of choice.Surgical resection (diverticulectomy), endoscopic sphincterotomy, and papillary balloon dilatation are treatment options when conservative management fails.
1934年，莱梅尔首次报告了存在毗邻乳头的憩室与肝内胆管胰腺疾病（不包括胆石症）。由壶腹周围十二指肠憩室（PAD）导致的梗阻性黄疸，在不存在胆总管结石或肿瘤的情况下，被称为莱梅尔综合征。本文介绍了一名患有腔外十二指肠憩室并伴有梗阻性黄疸和胰腺炎的患者。尽管最初采用保守治疗，但患者在2个月后症状复发，随后成功进行了十二指肠憩室手术切除。
对于无肿瘤、狭窄或胆石症的胰胆疾病患者，应考虑莱梅尔综合征。应首先考虑非侵入性影像学检查，但内镜逆行胰胆管造影（ERCP）仍是首选诊断方法。当保守治疗失败时，手术切除（憩室切除术）、内镜括约肌切开术和乳头球囊扩张术是治疗选择。
