PDF(Pubmed)
Abstract：
Lemmel syndrome, characterized by biliary and pancreatic duct obstruction secondary to a periampullary duodenal diverticulum (PAD), remains a rare and often overlooked diagnosis. Although duodenal diverticula are found in approximately 23% of the population, only about 5% of these cases lead to complications such as obstructions. A new case of Lemmel syndrome is demonstrated in the article about a middle-aged woman with chronic epigastric pain and right upper abdominal quadrant initially misdiagnosed as cholelithiasis. The accuracy of diagnosis was made possible by multimodal imaging methods, such as ultrasound, magnetic resonance cholangiopancreatography (MRCP), and computed tomography (CT) with oral contrast when a diffuse common bile duct was compressed by a PAD. Additionally, it highlights the necessity of including Lemmel syndrome in cases where patients have dilated bile ducts without calculi or mass lesions while emphasizing advanced imaging techniques for the revelation of structural malformations that underlay these conditions. The endoscopic intervention was minimally invasive but effective in relieving symptoms through sphincterotomy followed by laparoscopic cholecystectomy and biliary stent placement, thus making a point of the need for multiple disciplinary approaches toward treatment rare phenomenon like this one. This case report not only sheds light on the diagnostic and therapeutic avenues for Lemmel syndrome but also serves as a valuable educational resource for healthcare professionals. It emphasizes the need for heightened clinical vigilance and the adept use of imaging modalities in cases of biliary obstruction with obscure etiology. By contributing to the growing knowledge of this rare condition, we aim to facilitate timely diagnosis and optimize patient outcomes.
摘要：
Lemmel综合征,以继发于十二指肠壶腹周围憩室（PAD）的胆道和胰管阻塞为特征，仍然是一种罕见且经常被忽视的诊断。尽管在大约23％的人口中发现了十二指肠憩室，这些病例中只有约5％会导致阻塞等并发症。在文章中证明了一例新的Lemmel综合征，该患者患有慢性上腹痛和右上腹部象限，最初被误诊为胆石症。多模态成像方法使诊断的准确性成为可能，比如超声波，磁共振胰胆管成像（MRCP），当弥漫性胆总管被PAD压缩时，用口腔造影进行计算机断层扫描（CT）。此外,它强调了在胆管扩张而无结石或肿块性病变的患者中纳入Lemmel综合征的必要性,同时强调了先进的成像技术,以揭示这些疾病背后的结构畸形.内镜介入是微创的，但通过括约肌切开术，然后腹腔镜胆囊切除术和胆道支架置入术有效缓解症状。因此，需要采取多种学科方法来治疗像这样的罕见现象。此病例报告不仅阐明了Lemmel综合征的诊断和治疗途径，而且还为医疗保健专业人员提供了宝贵的教育资源。强调在病因不明的胆道梗阻病例中，需要提高临床警惕和熟练使用影像学检查方法。通过促进对这种罕见情况的了解，我们的目标是促进及时诊断和优化患者预后.
