Lemmel’s Syndrome With an Unusual Clinical Onset: Lessons Learned Based on This Patient Case

Lemmel’s syndrome is a rare disease caused by periampullary duodenal diverticula that can compress the bile ducts, causing non-obstructive jaundice. The diagnosis is not easy due to the lack of knowledge and non-specificity of symptoms. In most patients, the periampullary diverticulum causes mild compression and is asymptomatic, but if the compression of the bile ducts is significant and prolonged over time, it can cause cholangitis, lithiasis, as well as jaundice. Sonography can highlight the dilation of the left bile ducts that is typical of the disease and exclude the lithiasic nature of the obstruction. Computed tomography or magnetic resonance imaging contributes to the diagnosis and, in addition to highlighting the periampullary duodenal diverticulum, can exclude other causes of biliary tract compression. The diverticulum can also be highlighted with fluoroscopy and endoscopic retrograde cholangiopancreatography. The treatment of choice is surgery with removal of the diverticulum, but alternatively it can be conservative with endoscopic emptying of the diverticulum. This study documents a case with unusual onset and acute intestinal obstruction.