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Previous cholecystectomy and choledochal sphincter spasm after morphine sedation
1Department of Anaesthesia and Intensive Care, Prince of Wales Hospital and Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, PRC. hoamh@hotmail.com
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|January 8, 2000
Summary
Postoperative morphine can cause choledochal sphincter spasm, particularly in patients with a history of cholecystectomy. Naloxone effectively relieved the patient's symptoms, suggesting its utility in managing this condition.
Area of Science:
- Gastroenterology
- Anesthesiology
- Clinical Pharmacology
Background:
- Morphine administration can precipitate adverse gastrointestinal effects.
- Sphincter of Oddi dysfunction is a known complication of certain medications.
Observation:
- A 60-year-old male developed severe right upper quadrant abdominal pain post-femoral-popliteal artery bypass grafting.
- The patient had received preoperative morphine and scopolamine and had a prior cholecystectomy.
- Pain resolved rapidly following intravenous naloxone administration.
Findings:
- The clinical presentation strongly suggested choledochal sphincter spasm.
- A history of cholecystectomy was identified as a potential predisposing factor.
- Naloxone's efficacy indicated an opioid-mediated mechanism.
Implications:
- Choledochal sphincter spasm should be considered in the differential diagnosis of postoperative abdominal pain following morphine.
- Patients with a history of cholecystectomy may be at increased risk.
- This case highlights the importance of recognizing medication-induced sphincter dysfunction.