SHM Converge Scientific Abstract ePoster Gallery-Duodenal Diverticulitis With Lammel Syndrome: Rare Etiology of Abdominal Pain

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This case report describes a rare presentation of periampullary duodenal diverticulitis causing Lemmel syndrome, alongside concurrent sigmoid diverticulitis with colovesical fistula. Non-Meckel small bowel diverticula are uncommon and usually asymptomatic, but can occasionally cause complications such as diverticulitis, obstruction, or bleeding. Lemmel syndrome occurs when a periampullary duodenal diverticulum compresses the common bile duct, leading to biliary obstruction and sometimes cholangitis or pancreatitis.<br /><br />The patient was a 74-year-old woman with one day of progressive epigastric, right upper quadrant, and left upper quadrant pain, without fever, jaundice, vomiting, or GI bleeding. Exam showed abdominal tenderness but no peritoneal signs. Labs revealed mild leukocytosis and elevated AST and alkaline phosphatase, with normal bilirubin. Urinalysis and culture showed pyuria and bacterial growth. CT of the abdomen and pelvis demonstrated two key findings: mild acute-on-chronic sigmoid diverticulitis complicated by a colovesical fistula, and periampullary duodenal diverticulitis with mild dilation of the common bile duct and intrahepatic ducts, consistent with Lemmel syndrome.<br /><br />She was treated conservatively with antibiotics, and colorectal surgery recommended outpatient follow-up. At two weeks, liver enzymes normalized and repeat CT showed resolution of duodenal diverticulitis, leaving only colonic diverticulosis and a periampullary duodenal diverticulum without active inflammation.<br /><br />A literature review found only five prior case reports of periampullary duodenal diverticulitis causing Lemmel syndrome. Most patients presented with abdominal pain and were managed conservatively, often with improvement on follow-up imaging. The authors conclude that small bowel diverticulitis, though rare, should be considered in patients with abdominal pain, especially when accompanied by signs of cholestasis.

Asset Subtitle

Bibek Saha

Meta Tag

Author List Anjul Verma, Bibek Saha, Samuel Jang, Victoria Kalinoski-DuBose, William Mundell

Category Clinical Vignettes

Concept Duodenal Diverticula

Concept Lemmel syndrome

Concept Duodenal diverticulum

Concept Periampullary Duodenal Diverticulitis

Concept Common Bile Duct Obstruction

Distinguished Non-Finalist

Presenter Organization Mayo Clinic Rochester, MN

Presenting Author Bibek Saha

Track Adult

Keywords

Lemmel syndrome

periampullary duodenal diverticulitis

duodenal diverticulum

sigmoid diverticulitis

colovesical fistula

biliary obstruction

common bile duct dilation

abdominal pain

conservative treatment

small bowel diverticulitis

Duodenal Diverticula

Lemmel syndrome

Duodenal diverticulum

Periampullary Duodenal Diverticulitis

Common Bile Duct Obstruction