Background: Lemmel syndrome is a rare cause of obstructive jaundice resulting from extrinsic compression of the common bile duct (CBD) by a periampullary duodenal diverticulum. It occurs in the absence of choledocholithiasis or malignancy and is frequently overlooked due to its nonspecific clinical presentation. Case Presentation: A 74-year-old male presented with progressive jaundice, intermittent fever, pruritus, dyspepsia, and upper abdominal discomfort for one month. Initial investigations demonstrated biliary dilatation without evidence of choledocholithiasis. Contrast-enhanced computed tomography (CECT) and endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a large periampullary duodenal diverticulum compressing the distal CBD, consistent with Lemmel syndrome. Despite endoscopic therapy and medical management, the patient developed persistent cholangitis and worsening jaundice. Surgical exploration was performed, and cholecystectomy with choledochotomy, CBD stent insertion, and peritoneal toileting were carried out. No gallstones or CBD stones were identified intraoperatively. The postoperative course was uneventful, with progressive normalization of liver function tests and resolution of jaundice. Conclusion: Lemmel syndrome is an uncommon but important differential diagnosis in elderly patients with obstructive jaundice. Awareness of this entity and appropriate imaging are essential for early diagnosis. Endoscopic therapy is the preferred initial approach, but surgical intervention provides effective treatment when endoscopic management fails.
Wyke et al. (Sat,) studied this question.