Lasboo Masome Aghaei, Machiani Soroush Ahmadi, Yazdian Fatemeh Askari
Department of Internal Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Department of Internal Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Int J Surg Case Rep. 2025 Jun;131:111430. doi: 10.1016/j.ijscr.2025.111430. Epub 2025 May 13.
Lemmel syndrome is a rare condition causing obstructive jaundice, resulting from the compressive effect of a periampullary diverticulum (PD) on the common bile duct (CBD). This syndrome is unique as it occurs in the absence of gallstones or tumors. Accurate diagnosis is critical to prevent unnecessary interventions.
We present the case of a 66-year-old man who developed generalized jaundice, significant weight loss, and epigastric pain. Diagnostic imaging, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), revealed a periampullary duodenal diverticulum (PAD) compressing the distal CBD, leading to luminal dilatation without the presence of stones or malignancy. The patient was managed conservatively with antibiotics and supportive care, resulting in clinical improvement.
This case highlights the diagnostic challenges of Lemmel syndrome, a condition frequently misdiagnosed due to its rarity and nonspecific presentation. Imaging plays a pivotal role in distinguishing this syndrome from other causes of obstructive jaundice, such as malignancies or gallstones. Conservative management proved effective, underscoring the importance of non-invasive approaches.
Lemmel syndrome should be considered in patients with obstructive jaundice and periampullary diverticulum, particularly in the absence of stones or tumors. Accurate diagnosis is essential to avoid unnecessary surgical or invasive procedures, as conservative treatment can lead to favorable outcomes.
莱梅尔综合征是一种导致梗阻性黄疸的罕见病症，由壶腹周围憩室（PD）对胆总管（CBD）的压迫作用引起。该综合征的独特之处在于其发生时不存在胆结石或肿瘤。准确诊断对于避免不必要的干预至关重要。
我们报告一例66岁男性患者，出现全身黄疸、显著体重减轻和上腹部疼痛。包括超声、计算机断层扫描（CT）和磁共振成像（MRI）在内的诊断性影像学检查显示，壶腹周围十二指肠憩室（PAD）压迫胆总管远端，导致管腔扩张，且无结石或恶性肿瘤。患者接受抗生素和支持性治疗的保守治疗，临床症状改善。
该病例突出了莱梅尔综合征的诊断挑战，由于其罕见性和非特异性表现，该病症常被误诊。影像学检查在区分该综合征与其他梗阻性黄疸病因（如恶性肿瘤或胆结石）方面起着关键作用。保守治疗被证明有效，强调了非侵入性方法的重要性。
对于患有梗阻性黄疸和壶腹周围憩室的患者，应考虑莱梅尔综合征，尤其是在没有结石或肿瘤的情况下。准确诊断对于避免不必要的手术或侵入性操作至关重要，因为保守治疗可带来良好的结果。
