A case of lemmel syndrome with pancreaticobiliary maljunction

Abstract

Lemmel Syndrome, which is cholangitis and/or pancreatitis due to intraduodenal diverticulum, is rarely experienced. Indication for surgery is considered for severe and/or repeated symptoms. We report herein a case of Lemmel syndrome with pancreaticobiliary maljunction, with a review of the literature.
A 49-year-old male complaining of general fatigue, upper abdominal pain, jaundice and nausea was admitted to our hospital in May 2008. Contrast-enhanced abdominal CT scan revealed the stenosis of the lower common bile duct due to duodenal diverticula, and thickening of the gallbladder wall. He was diagnosed as having Lemmel syndrome and suspected gallbladder cancer with acute pancreatitis and cholangitis. After recovery from these inflammations we conducted resection of the diverticulum and cholecystectomy with liver bed resection. Because intraoperative cholangiography revealed pancreaticobiliary maljunciton, we added bile duct resection and choledocojejunostomy. On the 16th post-operative day he was discharged without any complications. Of 97 previously reported cases, surgery was performed in 69 cases (71.1%) including 18 cases in which surgery was done for bouts of recurrence after conservative treatment. We consider that candidates for surgery must always be selected in terms of possible recurrence of the disease and complications.