Battah Arwa, Farouji Iyad, DaCosta Theodore R, Luke Nicholas D, Shamoon Dema, DaCosta Theodore, Bains Yatinder
Internal Medicine, Saint Michael's Medical Center, Newark, USA.
Cardiology, Saint Michael's Medical Center, Newark, USA.
Cureus. 2023 Mar 16;15(3):e36236. doi: 10.7759/cureus.36236. eCollection 2023 Mar.
Periampullary diverticula are outpouches in the mucosa in the duodenum surrounding the ampulla of Vater. Most cases of periampullary diverticuli are asymptomatic, but complications can arise, increasing a patient's mortality. Diagnosis of periampullary diverticuli is often incidental during endoscopy or imaging studies for abdominal pain. When a patient with periampullary diverticuli is symptomatic, imaging modalities such as CT scan and MRI can help make the diagnosis, but a side-viewing endoscope provides direct visualization of the diverticuli and also allows for the potential treatment of the disease. Lemmel's syndrome is a complication of periampullary diverticuli where the diverticuli causes mechanical obstruction of the bile duct leading to obstructive jaundice without choledocholithiasis. These patients are at risk for further complications such as sepsis and perforation. Early diagnosis and treatment of these patients can help to prevent further complications from arising. We are presenting a case of Lemmel's syndrome with obstructive jaundice from a periampullary diverticuli, further complicated by cholangitis without dilation of the biliary tree.
壶腹周围憩室是十二指肠内围绕十二指肠乳头的黏膜处的袋状突出物。大多数壶腹周围憩室病例无症状，但可能出现并发症，增加患者死亡率。壶腹周围憩室的诊断通常在内镜检查或腹痛的影像学检查中偶然发现。当壶腹周围憩室患者出现症状时，CT扫描和MRI等影像学检查有助于诊断，但侧视内镜可直接观察憩室，还可对疾病进行潜在治疗。莱梅尔综合征是壶腹周围憩室的一种并发症，憩室导致胆管机械性梗阻，引发无胆总管结石的梗阻性黄疸。这些患者有发生败血症和穿孔等进一步并发症的风险。对这些患者进行早期诊断和治疗有助于预防进一步并发症的发生。我们报告一例由壶腹周围憩室引起梗阻性黄疸的莱梅尔综合征病例，该病例进一步并发胆管炎且胆管树未扩张。
