# A Case of Jaundice Revealing a Hidden Duo: Lemmel’s Syndrome and a Duplicated Gallbladder

## TL;DR

A rare case of jaundice reveals the coexistence of a duplicated gallbladder and Lemmel's syndrome, highlighting diagnostic and treatment challenges.

## Contribution

This case report documents the rare co-occurrence of gallbladder duplication and Lemmel's syndrome, emphasizing diagnostic complexities.

## Key findings

- A duplicated gallbladder with calculous cholecystitis was confirmed in a patient with obstructive jaundice.
- Lemmel's syndrome was identified as the cause of biliary obstruction despite no stones found in the common bile duct.
- Preoperative imaging and ERCP were critical for diagnosis and management of the complex biliary anomalies.

## Abstract

Gallbladder duplication is a rare congenital anomaly, often discovered incidentally. Its association with other biliary pathologies, such as choledocholithiasis and Lemmel's syndrome (obstructive jaundice due to periampullary duodenal diverticulum), is uncommon. This case highlights the diagnostic and therapeutic challenges in managing such a complex presentation.

A 62-year-old woman, presenting with fever, right upper quadrant pain, and deranged liver function tests, unveiled a diagnostic enigma. Initial ultrasonography suggested the presence of choledocholithiasis, though this finding was later re-evaluated. Subsequent magnetic resonance cholangiopancreatography (MRCP) identified a duplicated gallbladder, with one lobe showing signs of calculous cholecystitis, as well as an 8 mm dilation of the common bile duct (CBD) with a possible filling defect. Adding to the complexity, a large duodenal diverticulum was also identified in the MRCP. Side-viewing duodenoscopy revealed a type II major duodenal papilla. Although initial imaging suggested a filling defect in the CBD, endoscopic retrograde cholangiopancreatography (ERCP) found no stones, and the cause of the biliary obstruction remained unclear. The patient underwent laparoscopic cholecystectomy. The surgical specimen confirmed a rare duplication of the gallbladder with multiple pigment stones in one lobe and chronic cholecystitis. The dilated CBD and obstructive jaundice were attributed to Lemmel's syndrome.

This case demonstrates the rare coexistence of a gallbladder duplication and Lemmel's syndrome. Preoperative imaging is crucial for accurate diagnosis and surgical planning in patients with gallbladder anomalies. ERCP plays a vital role in both the diagnosis and treatment of Lemmel's syndrome. This case emphasizes the importance of considering rare anatomical variations and their potential impact on clinical presentation and management.