Sphincter of Oddi dysfunction
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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.
- type I will present with
type II will present with
- biliary pain
- either abnormal liver enzymes or dilation of the common bile duct
- type III presents with only biliary pain and no objective criteria 3
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.
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.
- 1. Cotton PB, Elta GH, Carter CR, Pasricha PJ, Corazziari ES. Rome IV. Gallbladder and Sphincter of Oddi Disorders. (2016) Gastroenterology. doi:10.1053/j.gastro.2016.02.033 - Pubmed
- 2. Sostre S, Kalloo AN, Spiegler EJ, Camargo EE, Wagner HN. A noninvasive test of sphincter of Oddi dysfunction in postcholecystectomy patients: the scintigraphic score. (1992) Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 33 (6): 1216-22. Pubmed
- 3. Bistritz L, Bain VG. Sphincter of Oddi dysfunction: managing the patient with chronic biliary pain. (2006) World journal of gastroenterology. 12 (24): 3793-802. doi:10.3748/wjg.v12.i24.3793 - Pubmed
- 4. Girometti R, Brondani G, Cereser L et al. Post-Cholecystectomy Syndrome: Spectrum of Biliary Findings at Magnetic Resonance Cholangiopancreatography. Br J Radiol. 2010;83(988):351-61. doi:10.1259/bjr/99865290 - Pubmed