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Surgical resection of duodenal diverticulum due to Lemmel’s syndrome: a case report


Gastroenterology & Hepatology: Open Access
João Alfredo Diedrich Neto, Marcos Orestes Gonçalves, Vanessa Santos Andrade Cruz Vento, Bruno Alves Vento, Carolina Bittencourt Letzov, Vinicius beck da Silveira, Eduarda Paitl Augustine, Arthur Freccia, Luize Cristine Dias, Gabriella Laís Braa

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Abstract

Periampullary diverticulum is an extra-luminal structure found within 2-3cm from the ampulla of Vater. Those formations are are mostly asymptomatic and might be found incidentally. However, PAD is the most common cause of Lemmel’s syndrome, which is defined as obstructive jaundice caused in absence of choledocholithiasis or tumor. The present study describes a case of surgical resection of periampullary diverticulum a 56-year-old male with a past medical history significant for videolaparoscopic cholecystectomy (performed 7years ago), presented to the emergency room with 8hours of sharp epigastric pain and laboratory results alterated. MRCP showed mild dilatation of the intrahepatic biliary tract.

 

For symptomatic patients, endoscopic intervention and surgical ressection are the most common techniques for treatment but the options vary based on symptomology and the pathophysiology of the subtype of Lemmel’s syndrome. In this case, diverticulostomy and internal choledocho-duodenostomy with PDS separated suture was performed to the treatment. The follow-up laboratory values revealed normalization and the postoperative period had no complications.

Keywords

periampullary diverticulum, Lemmel’s syndrome, cholangitis, surgical resection

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