Sphincter of Oddi dysfunction

Last revised by Dr Daniel J Bell on 24 Feb 2021

Sphincter of Oddi dysfunction is a functional disorder in which stenosis or dyskinesia of the sphincter of Oddi obstructs drainage from the common bile duct (CBD).

The disorder is associated with a history of cholecystectomy, in which case it is also called post-cholecystectomy syndrome. The vast majority of affected patients are women.

The disorder presents with biliary-type abdominal pain or recurrent pancreatitis 1.

The CBD is often dilated (>8 mm). In the setting of prior cholecystectomy, this is not specific for sphincter of Oddi dysfunction. However, in the appropriate clinical context, namely biliary pain and normal liver function tests, a dilated bile duct is supportive of the diagnosis 1.

CT can also demonstrate dilated bile or pancreatic ducts. CT can be used to document recurrent attacks of acute pancreatitis.

MRCP may be used to exclude choledocholithiasis and other structural abnormalities, as the exclusion of these is required to diagnose biliary sphincter of Oddi dysfunction 1.

The static images and time-activity curves in a hepatobiliary scintigram (HIDA scan) can be evaluated in a semi-quantitative manner 2. With sphincter of Oddi dysfunction, there is increased time to hepatic peak, delayed biliary visualization, delayed clearance of radiotracer from the dilated bile ducts, and prolonged biliary to bowel transit.

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Cases and figures

  • Case 1: morphine-induced
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  • Case 2: cocaine-induced
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  • Case 3: post-cholecystectomy syndrome
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  • Case 4: sphincter of Oddi dysfunction - type 2
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