CONCOMITANT LEMMEL’S SYNDROME AND PANCREAS DIVISUM: DIAGNOSTIC COMPLEXITY AND THERAPEUTIC APPROACH ykairnmv@gmail.com

 

CONCOMITANT LEMMEL’S SYNDROME AND PANCREAS DIVISUM: DIAGNOSTIC COMPLEXITY AND THERAPEUTIC APPROACH

4

Colombia

Oral or Poster

Lemmel’s syndrome is an uncommon entity characterized by extrinsic compression of the biliary tract caused by a periampullary duodenal diverticulum, occurring in the absence of choledocholithiasis or malignancy. This condition may trigger pancreatitis and present with jaundice and abdominal pain. Pancreas divisum is a congenital anomaly in which the dorsal and ventral pancreatic ducts fail to fuse, predisposing to recurrent pancreatitis. Both require a multidisciplinary diagnostic and therapeutic approach, frequently involving surgical or endoscopic intervention.

We present a case report accompanied by a critical review of the literature on the coexistence of Lemmel’s syndrome and pancreas divisum—an exceptionally rare association. This work discusses diagnostic complexity and therapeutic considerations arising from this unusual combination.

A female patient presented with recurrent pancreatitis, chronic abdominal pain, jaundice, and elevated liver enzymes. Accurate diagnosis was achieved through advanced imaging techniques. She underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement and endoscopic sphincterotomy, resulting in prompt clinical improvement. Post-treatment, the patient experienced resolution of jaundice, significant reduction of abdominal pain—the main reason for consultation—normalization of liver enzymes, and no recurrence of pancreatitis during follow-up.

ERCP with biliary stenting is an effective, minimally invasive therapeutic option for patients with concomitant Lemmel’s syndrome and pancreas divisum. Given their rarity in isolation and exceptional coexistence, these conditions pose significant diagnostic challenges. Early recognition and targeted intervention can substantially improve patient outcomes and quality of life.