P-EGS16 Lemmel Syndrome due to Duodenal Diverticulitis, an Infrequent Cause of Biliary Obstruction

Abstract Background Lemmel syndrome, first described in 1934, is the presence of biliary obstruction as a consequence duodenal diverticula. The precise aetiology remains uncertain. Multiple causative theories have been proposed. These include mechanical biliopancreatic duct occlusion, functional disruption sphincter Oddi and alteration course distal pancreatic ducts. We present case caused by diverticulitis solitary diverticulum. Methods A 71-year-old woman with no co-morbidities presented early satiety, cachexia upper abdominal pain. An epigastric mass was palpable, alkaline phosphatase 247 iu/L, alanine transaminase 124iu/L, bilirubin 4umol/L C-reactive protein 68mg/L. Computed tomography (CT) abdomen pelvis revealed obstructed tree D2 diverticulitis. Magnetic resonance cholangiopancreatography (MRCP) displayed enterolith. Treatment antibiotics initiated patient commenced on liquid diet. Liver function tests inflammatory markers normalised. After seven day admission discharged oral intake Interval MRCP resolution inflammation. Results Duodenal diverticula occur 1-20% individuals. Complications are symptoms uncommon. Diverticulitis rare complication. Malignancy cholelithiasis should be excluded diagnostic workup. mainstay therapy for conservative. CT effective tools. Diverticulectomy carries substantial risk morbidity mortality. Endoscopic sphincterotomy or lavage role relief when present. Comparative prospective studies management do not exist retrospective enquiry sparse. Management thereby best determined clinically basis. Surgery reserved failed conservative medical therapy. Conclusions considered patients unexplained pain elevated markers. In combination obstructive jaundice, suspicions raised acute inflammation causing to tree. Cross sectional imaging useful determining diagnosis. Antibiotics prudent line absence perforation. Where these measures inadequate endoscopic operative strategies may employed but robust evidence