Detailed Abstract
[E-poster - Biliary & Pancreas (Biliary Disease/Surgery)]
[EP 199] Case Series Report of Biliary Obstruction Due to Periampullary Duodenal Diverticulum ( Lemmel Syndrome)
Hung DANG NGOC 1, Phong TRAN AN 1, Thanh DANG NHU 2, Vi LE THI TUONG 4, Thien DANG HUU 3
1 Department of Digestive Surgery, Hue Central Hospital, VIETNAM, 2 Department of Surgery, Hue University of Medicine And Pharmacy, VIETNAM, 3 College of Health Sciences, Vin University, VIETNAM, 4 Department of Radiology, Hue University of Medicine And Pharmacy, VIETNAM
Background : Lemmel Syndrome refers to obstructive jaundice caused by periampullary duodenal diverticula (PDD), without the presence of choledocholithiasis or neoplasia. We present three instances of obstructive jaundice caused by peripapillary diverticulum, which were treated using different management at Hue Central Hospital in Vietnam.
Methods : A prospective report on three cases of peripapillary diverticulum-related biliary obstruction that were detected and treated at Hue Central Hospital in Hue City, Vietnam between April 2022 and August 2023
Results : The three patients were all above the age of 60 and exhibited clinical symptoms of obstructive jaundice and biliary infection. Diagnostic tests revealed elevated levels of bilirubinemia and liver enzymes. The imaging tests, which included Abdominopelvic CT scan, MRCP and EUS revealed the intra and extra-hepatic bile ducts dilation because of the compression caused by a periampullary diverticulum. No evidence of stones or tumors as the reason was identified. Interventional ERCP was conducted on all three patients, which confirmed the presence of peripapillary diverticula. In the first patient, we opted for Hyoscine-N-butylbromide as an alternative internal treatment after an unsuccessful sphincterotomy. In two other patients, we conducted either sphincterotomy or biliary stent implantation, depending on the extent of constriction in the common bile duct.
Conclusions : Peripapillary diverticulum is a seldom discussed cause of biliary obstruction in clinical practice. Imaging techniques such as CT scan, MRCP, or EUS aid in the diagnosing process. ERCP aids in verifying the diagnosis. The diversity of management approaches is contingent upon the patient's condition.
Methods : A prospective report on three cases of peripapillary diverticulum-related biliary obstruction that were detected and treated at Hue Central Hospital in Hue City, Vietnam between April 2022 and August 2023
Results : The three patients were all above the age of 60 and exhibited clinical symptoms of obstructive jaundice and biliary infection. Diagnostic tests revealed elevated levels of bilirubinemia and liver enzymes. The imaging tests, which included Abdominopelvic CT scan, MRCP and EUS revealed the intra and extra-hepatic bile ducts dilation because of the compression caused by a periampullary diverticulum. No evidence of stones or tumors as the reason was identified. Interventional ERCP was conducted on all three patients, which confirmed the presence of peripapillary diverticula. In the first patient, we opted for Hyoscine-N-butylbromide as an alternative internal treatment after an unsuccessful sphincterotomy. In two other patients, we conducted either sphincterotomy or biliary stent implantation, depending on the extent of constriction in the common bile duct.
Conclusions : Peripapillary diverticulum is a seldom discussed cause of biliary obstruction in clinical practice. Imaging techniques such as CT scan, MRCP, or EUS aid in the diagnosing process. ERCP aids in verifying the diagnosis. The diversity of management approaches is contingent upon the patient's condition.
SESSION
E-poster
E-Session 03/21 ALL DAY