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Sphincter of Oddi Dysfunction: A Perplexing Presentation.

Sana Ahmad Din1, Iman Naimi1, Mirza Beg1

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Summary
This summary is machine-generated.

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.

Keywords:
Abdominal painCholecystectomyEndoscopic retrograde cholangiopancreatographyPediatricsSphincter of Oddi

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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.