Yagnik Karan, Gaddameedi Sai, Ravilla Jayasree, Chhabria Payal, Rathod Malay, Vangala Anoohya, Du Doantrang, Terrany Ben
Internal Medicine, Monmouth Medical Center, Long Branch, USA.
Medicine, Monmouth Medical Center, Long Branch, USA.
Cureus. 2024 Dec 26;16(12):e76442. doi: 10.7759/cureus.76442. eCollection 2024 Dec.
Lemmel syndrome involves a periampullary duodenal diverticulum (PAD), a pouch-like outpouching near the ampulla of Vater, compressing the common bile duct. We describe a case of severe abdominal pain in a patient who had a large periampullary diverticulum, managed with surgical intervention after an initial failed endoscopic retrograde cholangiopancreatography (ERCP). An elderly female patient in her early 90s arrived at the emergency department with severe cramping pain localized to the right upper quadrant of her abdomen, progressively intensifying over several weeks. Her blood pressure measured 161/68 mmHg, while other vital signs and the physical exam showed no abnormalities. A CT scan of the chest, abdomen, and pelvis with IV contrast revealed both biliary and pancreatic duct dilation, along with choledocholithiasis and a possible obstructing lesion at the pancreatic head. Further imaging with MRI and MRCP confirmed choledocholithiasis, dilation of the common bile duct (CBD), and the presence of a duodenal diverticulum. The initial attempt at endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessful due to a large periampullary diverticulum, leading to the placement of a temporary percutaneous cholecystostomy tube. In a subsequent ERCP, the stones were successfully removed. During the same hospital stay, she underwent cholecystectomy and was later discharged. Patients experiencing right upper quadrant (RUQ) pain should consider Lemmel syndrome as one of the differential diagnoses. Although rare, it is a treatable condition that, if overlooked, can result in repeated hospitalizations and ongoing investigations. The altered anatomy associated with this syndrome can complicate standard medical procedures, requiring physicians to adapt their approach and utilize alternative methods.
莱梅尔综合征涉及壶腹周围十二指肠憩室（PAD），即靠近 Vater 壶腹的袋状膨出，压迫胆总管。我们描述了一例患有巨大壶腹周围憩室的患者出现严重腹痛的病例，该患者在初次内镜逆行胰胆管造影（ERCP）失败后接受了手术干预。一名 90 岁出头的老年女性患者因严重的绞痛来到急诊科，疼痛局限于上腹部右象限，在数周内逐渐加重。她的血压测量值为 161/68 mmHg，而其他生命体征和体格检查均未发现异常。胸部、腹部和骨盆的增强 CT 扫描显示胆管和胰管均扩张，伴有胆总管结石以及胰腺头部可能存在梗阻性病变。MRI 和 MRCP 的进一步影像学检查证实了胆总管结石、胆总管（CBD）扩张以及十二指肠憩室的存在。由于巨大的壶腹周围憩室，初次内镜逆行胰胆管造影（ERCP）尝试失败，导致放置了临时经皮胆囊造瘘管。在随后的 ERCP 中，结石被成功取出。在同一次住院期间，她接受了胆囊切除术，随后出院。出现上腹部右象限（RUQ）疼痛的患者应将莱梅尔综合征作为鉴别诊断之一。尽管罕见，但它是一种可治疗的疾病，如果被忽视，可能导致反复住院和持续检查。与该综合征相关的解剖结构改变会使标准医疗程序复杂化，要求医生调整方法并采用替代方法。
