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Sphincter of Oddi Dysfunction: A Perplexing Presentation
Sana Ahmad Din1, Iman Naimi1, Mirza Beg1
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, SUNY Upstate Medical University, Golisano Children's Hospital, Syracuse, NY, USA.
Case Reports in Gastroenterology
|January 20, 2017
Summary
Sphincter of Oddi dysfunction (SOD) can cause persistent abdominal pain after gallbladder removal. Endoscopic retrograde cholangiopancreatography with manometry confirmed elevated biliary sphincter pressure, resolving with sphincterotomy.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Science
Background:
- Sphincter of Oddi dysfunction (SOD) is a functional disorder affecting the sphincter of Oddi, potentially causing biliary obstruction.
- Chronic abdominal pain post-cholecystectomy can be challenging to diagnose and manage.
- This case highlights a diagnostic and therapeutic approach to persistent symptoms suggestive of SOD.
Observation:
- A 16-year-old female presented with chronic abdominal pain, nausea, and vomiting post-laparoscopic cholecystectomy.
- Initial investigations including ultrasound and esophagogastroduodenoscopy were inconclusive for the cause of persistent symptoms and elevated liver enzymes (ALT, AST).
- Empirical treatment with omeprazole and advanced imaging (MRCP) did not identify the underlying pathology.
Findings:
- Endoscopic retrograde cholangiopancreatography (ERCP) with manometry was crucial in diagnosing SOD by revealing elevated biliary sphincter pressure.
- Biliary sphincterotomy, a minimally invasive endoscopic procedure, was performed to relieve the obstruction.
- Successful sphincterotomy led to significant improvement in the patient's abdominal pain, nausea, and vomiting.
Implications:
- This case underscores the importance of considering SOD in patients with unexplained post-cholecystectomy symptoms.
- ERCP with manometry serves as a definitive diagnostic tool for SOD.
- Sphincterotomy is an effective treatment for confirmed SOD, improving patient outcomes and quality of life.
Keywords:
Abdominal painCholecystectomyEndoscopic retrograde cholangiopancreatographyPediatricsSphincter of OddiMore Related Videos
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