A case of a duodenal diverticulum causing obstructive jaundice - Lemmel`s syndrome.

Duodenum is the second most common location of intestinal diverticula. It is extremely rare that periampullary duodenal diverticulum causes obstructive jaundice. This rare condition was first described by German surgeon Gerhard Lemmel in 1934.(1) Lemmel's syndrome is defined as obstructive jaundice due to a periampullary duodenal diverticulum in the absence of choledocholithiasis or neoplasm. We present a case of a 69-year-old male patient admitted to our hospital for painless obstructive icterus. Diagnostic workup by use of MSCT revealed periampullary duodenal diverticulum (Figure 1) while MRCP and endoscopy confirmed duodenal diverticulum causing a focal short-segment stenosis in the distal segment of the choledochus with dilatation of intrahepatic and extrahepatic bile ducts proximally (Figure 2). Surgery was indicated and intraoperatively we detected markedly dilated choledochus in the segment thus exposed (Figure 3) so internal bile drainage was ensured by creating termino-lateral hepaticojejunal Roux-en-Y anastomosis. Although a number of treatment modalities such as diverticulectomy or endobiliary stent placement have been proposed, we consider that internal biliary drainage by creating hepaticojejunal Roux-en-Y anastomosis is the only appropriate and long-term option for these patients.(2,3).