Answer for BIR CoW 22 Mar 2026
Lemmels syndrome
Findings
Focal saccular outpouching noted arising from medial wall D1 segment of duodenum The outpouching causes mass effect over mid and distal common bile duct with upstream dilatation of hepatic ducts with mild central intrahepatic biliary radicle dilatation. On oral contrast administration, the contrast is noted filling the outpouching from D1 segment of duodenum.
Discussion
A periampullary diverticulum is characterized by the presence of extraluminal outpouchings of the duodenal wall located within a 2–3-cm radius from the ampulla of vater. Asymptomatic, and only 5–10% of affected patients show complications. Lemmel syndrome is an uncommon complication of a periampullary duodenal diverticulum that presents with abdominal pain and obstructive jaundice due to extrinsic compression of the common bile duct (CBD) by the Periampullary diverticulum without evidence of choledocholithiasis or a tumor.Other Complications of periampullary diverticula include Hemorrhage, Perforation, Fistula formation, Diverticulitis, Cholangitis, Pancreatitis, Gallstone formation.
Findings
Focal saccular outpouching noted arising from medial wall D1 segment of duodenum The outpouching causes mass effect over mid and distal common bile duct with upstream dilatation of hepatic ducts with mild central intrahepatic biliary radicle dilatation. On oral contrast administration, the contrast is noted filling the outpouching from D1 segment of duodenum.
Discussion
A periampullary diverticulum is characterized by the presence of extraluminal outpouchings of the duodenal wall located within a 2–3-cm radius from the ampulla of vater. Asymptomatic, and only 5–10% of affected patients show complications. Lemmel syndrome is an uncommon complication of a periampullary duodenal diverticulum that presents with abdominal pain and obstructive jaundice due to extrinsic compression of the common bile duct (CBD) by the Periampullary diverticulum without evidence of choledocholithiasis or a tumor.Other Complications of periampullary diverticula include Hemorrhage, Perforation, Fistula formation, Diverticulitis, Cholangitis, Pancreatitis, Gallstone formation.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!