Table 2.
Diagnostic tests and treatment modalities used during management of previously reported Lemmel syndrome cases
| Author | Laboratory data | Imaging modalities | Imaging findings | Interventions and treatments |
|---|---|---|---|---|
| Love et al. (2021) [23] | Lactic acid 6.3, T bili 1.0, normal LFTs | CT abdomen/pelvis with contrast, EGD/EUS | CBD dilatation (10 mm), PD dilatation (6 mm), GOO | ERCP removal of food debris, endoscopic diverticular tap-water lavage |
| Bellamlih et al. (2021) [11] | T bili 6, D bili 3.7, AST 234, ALP 398, ALP 334 GGT 339, CRP 40.7 | Abdominal US, CT abdomen/pelvis, MRCP, EUS | CBD dilatation (12 mm) | 14 days of IV abx |
| Bernshteyn et al. (2020) [6] | T bili 5.5, ALP 194, ALT 106, AST 260 | Abdominal US, CT abdomen/pelvis, MRI | CBD dilatation (12 mm) | IV abx, ERCP with CBD stent placement |
| Yanagaki et al. (2020) [8] | T bili 1.0, WBC 27K, AST 337, ALT 143, amylase 110, CRP 8.87 | CT abdomen/pelvis without contrast, CT abdomen/pelvis with contrast, MRCP | CBD dilatation (exact size not mentioned) | 12 days of IV abx, ERCP (for visualization), surgery (extrahepatic bile duct resection with cholecystectomy, hepaticojejunostomy, and diverticulectomy and papilloplasty) |
| Alzerwi, (2020) [19] | T bili 114, D bili 98, ALP 1058, AST 89, ALT 41, amylase 58, WBC 20.6, PLT 510 | KUB, abdominal ultrasound, CT abdomen/pelvis, MRCP | CBD dilatation (22 mm), PC dilatation (4.8 mm) | IV abx, ERCP (aborted), percutaneous transhepatic cholangiography and biliary drainage, surgery (sphincterotomy, ampullectomy, cholecystectomy, duodenotomy) |
| Tabata et al. (2019) [22] | T bili 3.7, AST 263, ALT 293, GGT 265, ALP 1181, CRP 6.27 | CT abdomen/pelvis | CBD dilatation (10 mm) | ERCP diverticular decompression via air suction, endoscopic sphincterotomy, IV abx |
| Frauenfeld et al. (2019) [20] case 1 | Elevated T bili (not specified) | Abdominal ultrasound (normal), CT abdomen without contrast | CBD dilatation (11 mm) | Nasogastric decompression, bowel rest |
| Frauenfeld et al. (2019) [20] case 2 | Elevated bilirubin metabolites, elevated inflammatory markers (values not specified) | Abdominal ultrasound, CT abdomen with contrast | CBD dilatation (13 mm) | 7 days of IV abx |
| Venkatana et al. (2019) [18] | T bili 3.5, alp 716, AST 88, amylase 84 (nL). CRP 133, WBC 11.69. Blood cultures + Klebsiella | CT abdomen with contrast, percutaneous transhepatic cholangiography (in setting of previous Billroth II) | CBD dilatation (value not mentioned) | Percutaneous transhepatic drainage and decompression |
| Oliveira et al. (2019) [17] | T bili 5.1, D bili 2.9, AST 171, ALT 243, ALP 236, GGT 374, CRP 13.2 | Abdominal ultrasound (normal), EGD, CT abdomen | CBD dilatation (7 mm) | Bowel rest, IV abx for 7 days |
| Tobin et al. (2018) [10] | T bili 27.4, ALT 741, ALP 517, GGT 426 | Abdominal ultrasound, MRCP, EGD | CBD dilatation (value not mentioned) | Not mentioned |
| Miyajima et al. (2018) [16] | T bili 6.2, AST 259, ALT 233, GGT 1734, ALP 1200, amylase 563, lipase 843, CRP 19.7, LDH 348, +E. tarda blood cultures | CT abdomen | CBD and PD dilatation (values not mentioned) | IV abx, ERCP, endoscopic papilloplasty and cannulation, endoscopic biliary drainage tube placement |
| Desai et al. (2017) [5] | All labs within normal limits | CT abdomen/pelvis with contrast | CBD dilatation (18 mm) | Bowel rest, 14 days of IV abx |
| Khan BA et al. (2017) [9] | T bili 2.9, D bili 1.4, Lipase 5,168, ALT 50, AST 59, ALP 156 | CT abdomen, MRCP | PD dilatation (value not mentioned) | IV fluids, bowel rest; eventual surgical diverticulectomy after recurrence of symptoms |
| Somani and Sharma (2017) [15] | T bili 5.5, AST 86, ALP 620 | Abdominal ultrasound, EUS | CBD dilatation (10 mm) | ERCP, endoscopic biliary sphincterotomy |
| Rouet et al. (2012) [21] | T bili 1.54 mg/dL | Abdominal ultrasound, CT abdomen | CBD and PD dilatation (values not mentioned), liver abscess | ERCP, endoscopic sphincterotomy; IV abx, percutaneous abscess drainage |
| Kang HS et al. (2014) [2] | T bili 2.37, AST 88, ALT 96, ALP 349, GGT 571, WBC 11.17, CRP 2.392 | CT abdomen, MRCP | CBD dilatation (value not mentioned) | ERCP biliary cannulation, endoscopic sphincterotomy, enterolith removal |
CT A/P, computerized tomography of abdomen and pelvis; CBD, common bile duct; PD, pancreatic duct; GOO, gastric outlet obstruction; abx, antibiotics.