Computed Tomographic Findings in Lemmel Syndrome: A Rare Cause of Obstructive Jaundice

Obstructive jaundice resulting from a duodenal diverticulum is known as Lemmel syndrome. Lemmel syndrome should be included in the differential diagnosis in patients presenting with obstructive jaundice in the absence of choledocholithiasis, mass, or a stricture.

To describe the computed tomography (CT) findings in patients with Lemmel syndrome.

Eighteen cases with incidentally detected peri-ampullary duodenal diverticula were retrospectively reviewed over a period of one year. Out of these, eight patients who presented to the hospital with jaundice with or without acute abdominal symptoms were included in the study. CT scans were acquired using the Philips Incisive CT 128 Slice machine, and the findings were recorded.

Jaundice was the presenting complaint in eight patients (100%) followed by fever in four (50%) patients and abdominal pain in three (37.5%) patients. Vomiting was observed in one patient (12.5%). All patients had evidence of obstructive biliopathy on baseline blood investigations. On CT, all patients had periampullary duodenal diverticula arising from the second part of the duodenum along with dilated common bile duct and mild intrahepatic bilobar biliary dilatation. Mild wall thickening and/or enhancement of bile ducts were seen in four patients, while evolving cholangitic abscesses were seen in two patients. Findings of acute pancreatitis and pneumobilia were observed in each patient.

Lemmel syndrome should be suspected in a patient with features of obstructive jaundice when choledocholithiasis, pancreatobiliary tumors, and strictures have been ruled out. Computed tomography remains the preferred imaging modality because of its easy accessibility, less time consumption, and non-invasive nature.