Lemmel's syndrome: Case report of a not feasible endoscopic management.

INTRODUCTION

Lemmel's syndrome is a rare disease presenting with obstructive jaundice, secondary to common bile duct compression by duodenal diverticulum.

PRESENTATION OF CASE: A 79-year-old female was admitted to our emergency department with cholangitis and obstructive jaundice, due to choledocal compression by two periampullary diverticula, with major papilla opening near the biggest one (periampullary diverticulum type III). Endoscopic retrograde cholangiopancreatography didn't succeed sphincterotomy, therefore laparoscopic rendez-vous was performed.

DISCUSSION: This case is an example of an unusual cause of obstructive jaundice, which should be mentioned along with choledocolithiasis and biliary or ampullary neoplasms, in order to avoid delay in diagnosis and management.

CONCLUSION

The commonest treatment of Lemmel's syndrome reported in literature is ERCP with sphincterotomy, but when endoscopic management fails, interventional radiology and surgery should also be considered.