Duodenal diverticulum obstructive jaundice syndrome (Lemmel Syndrome) refers to the presence of a duodenal diverticulum compressing the common bile duct, affecting the excretion of bile and pancreatic juice, leading to obstructive jaundice or pancreatitis symptoms. In 1934, Lemmel first described this syndrome and referred to cases with obvious common bile duct and pancreatic duct obstruction as the papillary syndrome (Pepiller Syndrome).

bubble_chart Pathogenesis

The common site of duodenal diverticula is on the inner side of the duodenum, which is usually asymptomatic and thus easily overlooked. However, once the diverticulum compresses the duodenal opening of the common bile duct, it can affect the excretion of bile and pancreatic juice, leading to bile and pancreatic fluid stasis. This increases the pressure within the duct lumen, potentially triggering pancreatic inflammation or obstructive jaundice. In some patients, the common bile duct opens into the diverticulum or partially into it, which can easily lead to Lemmel syndrome. This is especially true when combined with diverticulitis or even malignant transformation, increasing the likelihood of this syndrome and the risk of ascending infection.

bubble_chart Clinical Manifestations

Clinically, there may be intermittent abdominal pain, bloating, acid reflux, belching, etc. If complicated by diverticulitis, the symptoms may become more pronounced, and occasionally upper gastrointestinal bleeding may occur. Obstructive jaundice caused by diverticulitis may lessen or even completely subside once the inflammation is under control, but jaundice may reappear if the condition worsens. Pancreatitis caused by diverticulitis is usually of the acute edematous type, but severe ascending infections can also lead to suppurative or necrotizing pancreatitis, presenting symptoms such as abdominal pain, abdominal discomfort, nausea, vomiting, and diarrhea. The aforementioned clinical manifestations caused by diverticulitis are often triggered or exacerbated by eating.

1. Patients with a history of intermittent upper abdominal pain who develop jaundice should consider the possibility of this syndrome.
2. Upper consumptive thirst confirmed by upper gastrointestinal contrast imaging reveals dilation of the common bile duct.
3. Exclude gallstones, biliary tract infections, and other causes of obstructive jaundice and pancreatitis.

bubble_chart Treatment Measures

The treatment principles are the same as for duodenal ulcers. For example, administer gentamicin 80,000 units, three times daily. Additionally, add antacids to alleviate symptoms, such as omeprazole 20 mg once daily. Surgical treatment should be considered for patients who respond poorly to conservative therapy, experience perforation, or have obstruction of the common bile duct and pancreatic duct.

bubble_chart Complications

Concurrent diverticulitis.