Abstract：
We present a case involving a 67-year-old patient with a medical history of gastric bypass who was recently diagnosed with a 6-centimeter duodenal mass causing biliary duct stenosis. Despite our best efforts, we were unable to access this tumor endoscopically, necessitating surgical intervention. During the surgical exploration, we discovered a duodenal diverticulum filled with stones, leading to the obstruction of the biliary ductâ?\"a manifestation of Lemmel syndrome. This rare condition is characterized by obstructive jaundice in the absence of choledocholithiasis or tumors and is secondary to dilatation of peri-ampullary diverticula. While it is typically managed through endoscopy, our diagnostic and therapeutic approach was complicated by the patient\'s history of bariatric surgery (gastric bypass), making endoscopic access impossible despite our multiple attempts. This case report sheds light on the challenges posed by the concurrence of a rare pathology and surgically modified anatomy, which is increasingly encountered in daily surgical practice. In such situations, exploratory surgery continues to play a significant role.
摘要：
我们介绍了一个病例，该病例涉及一名67岁的患者，该患者有胃旁路病史，最近被诊断患有6厘米的十二指肠肿块，导致胆管狭窄。尽管我们尽了最大努力,我们无法通过内窥镜检查进入这个肿瘤，需要手术干预。在手术探查期间，我们发现了一个充满结石的十二指肠憩室，导致胆管阻塞？“Lemmel综合征的一种表现。这种罕见的疾病的特征是在没有胆总管结石或肿瘤的情况下出现阻塞性黄疸，并且继发于壶腹憩室周围的扩张。虽然通常通过内窥镜检查进行管理，我们的诊断和治疗方法因患者的减肥手术史（胃旁路术）而复杂化，尽管我们多次尝试，但仍无法进入内窥镜。该病例报告揭示了罕见病理和手术解剖结构的并发所带来的挑战。这在日常手术实践中越来越多地遇到。在这种情况下,探索性手术继续发挥重要作用。
