SHM Converge Scientific Abstract ePoster Gallery-A Rare Cause of Obstructive Jaundice: A Case of Lemmel's Syndrome

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Lemmel’s syndrome is a rare but important cause of obstructive jaundice caused by compression of the common bile duct by a periampullary duodenal diverticulum, without gallstones or malignancy. It is often underrecognized because symptoms are nonspecific and periampullary diverticula are relatively common in older adults.<br /><br />This case involved a 96-year-old woman with hyperlipidemia and dementia who was admitted with altered mental status, hypoxia, septic shock, and acute hypoxic respiratory failure. Although she denied fever, chills, nausea, vomiting, and weight loss, laboratory testing showed a cholestatic and hepatocellular pattern with elevated total bilirubin, direct bilirubin, alkaline phosphatase, AST, and ALT. White blood cell count was also elevated.<br /><br />Abdominal ultrasound demonstrated a dilated common bile duct and a fluid-filled gallbladder with small gallstones. CT of the abdomen and pelvis showed a markedly enlarged gallbladder, dependent stones, and a large 4.5 cm periampullary duodenal diverticulum, supporting suspected Lemmel’s syndrome. MRCP and ERCP were discussed for further diagnosis and possible treatment, but the patient’s family declined invasive intervention.<br /><br />The report emphasizes that Lemmel’s syndrome should be considered in elderly patients with obstructive jaundice when imaging does not show a clear malignant or stone-related cause. Ultrasound and CT may suggest biliary obstruction but may not clearly identify the diverticulum. MRCP can help define biliary anatomy, while ERCP remains the diagnostic gold standard and offers therapeutic options such as sphincterotomy or biliary stenting. Surgery is reserved for cases not amenable to endoscopic management.<br /><br />Early recognition is important because timely endoscopic treatment can relieve obstruction and prevent complications such as cholangitis and recurrent biliary symptoms.

Asset Subtitle

Deniece Meñez

Meta Tag

Author List Deniece Meñez, Emily Rodriguez, Hehui Quan, Neil Gambhir, Rujuta Patel, Tina J. Kana, Umair Abbas

Category Clinical Vignettes

Concept Lemmel syndrome

Concept Duodenal diverticulum

Concept Obstructive jaundice

Concept Biliary Obstruction

Concept Mechanical compression

Distinguished Non-Finalist

Presenter Organization Lenox Hill Hospital

Presenting Author Deniece Meñez

Track Adult

Keywords

Lemmel's syndrome

obstructive jaundice

periampullary duodenal diverticulum

common bile duct compression

elderly patient

cholestatic liver enzymes

biliary obstruction

MRCP

ERCP

cholangitis

Lemmel syndrome

Duodenal diverticulum

Obstructive jaundice

Biliary Obstruction

Mechanical compression