# An Atypical Presentation of Lemmel's Syndrome: A Rare Culprit of Intermittent Biliary Obstruction

## TL;DR

This paper describes a rare case of Lemmel's syndrome, where a duodenal diverticulum causes intermittent biliary obstruction without stones or tumors.

## Contribution

The paper highlights an atypical presentation of Lemmel's syndrome as a rare cause of intermittent biliary obstruction.

## Key findings

- Lemmel's syndrome can cause obstructive jaundice due to a periampullary duodenal diverticulum.
- The obstruction is intermittent, caused by stasis leading to enterolith or debris formation.
- Imaging shows dynamic obstructive processes with fluctuating bile duct caliber.

## Abstract

Lemmel's syndrome can cause obstructive jaundice due to a periampullary duodenal diverticulum, leading to biliary obstruction without stones or tumors. The blockage can be intermittent as stasis in the diverticulum promotes enterolith or debris formation, which may temporarily obstruct the bile duct, causing fluctuating symptoms.

Imaging features of Lemmel syndrome illustrating intermittent extrinsic compression of the common bile duct by a periampullary duodenal diverticulum. Current CT demonstrates abrupt CBD tapering with upstream biliary dilatation, while prior imaging shows preserved ductal caliber, supporting a dynamic obstructive process.