{'fraction_non_alphanumeric': 0.0213089802130898, 'fraction_numerical': 0.00380517503805175, 'mean_word_length': 5.54228855721393, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Lemmel syndrome: an uncommon complication of periampular duodenal diverticulum.

Lemmel's syndrome consists of obstructive jaundice due to compression of a periampular duodenal diverticulum in the absence of choledocholithiasis or tumour. Periampular duodenal diverticula are usually incidental findings, but they can be complicated. We present two cases. The first is a 79-year-old woman with hypertension and chronic kidney disease who starts with epigastric pain. Blood tests show cholestasis and a rise in bilirubin and pancreatic enzymes. Abdominal computed tomography with contrast confirms biliary dilation, parapapillary duodenal diverticulum and acute pancreatitis. Follow-up is decided. The second case is an 80-year-old man, without previous illness, with abdominal pain, fever and jaundice. Magnetic resonance cholangiopancreatography shows a 4 cm duodenal diverticulum displacing bile and pancreatic duct. ERCP is performed with the placement of a plastic biliary stent. The etiopathogenic theories of Lemmel syndrome are chronic ampullar inflammation, Oddi sphincter dysfunction due to the diverticulum or direct compression by diverticular content. The diagnosis of Lemmel syndrome is a challenge. It can be diagnosed by imaging tests, although the gold standard for diagnosis and treatment is ERCP.