Sphincter of Oddi disfunction: Case report

Authors

DOI:

https://doi.org/10.22516/25007440.550

Keywords:

Sphincter of Oddi dyskinesia, Endoscopic sphincterotomy, Scintigraphy, Endoscopic retrograde cholangiopancreatography

Abstract

Sphincter of Oddi dysfunction is a clinical syndrome caused by functional (dyskinesia) or structural (stenosis) disease. The estimated prevalence of this condition in the general population is 1%, reaching 20% in patients with persistent pain after cholecystectomy and 70% in patients with idiopathic recurrent acute pancreatitis. It is clinically characterized by the presence of abdominal pain, similar to biliary colic or pancreatic pain in the absence of organic biliary disease. It is also observed in patients with idiopathic recurrent pancreatitis, associated with elevated pancreatic or hepatic enzymes, and bile duct and/or pancreatic duct dilatation. Treatment for sphincter of Oddi dysfunction type I is based on endoscopic sphincterotomy, but there is controversy regarding the management of sphincter of Oddi dysfunction types II and III. This article presents the clinical case of a 67-year-old female patient with a history of cholecystectomy by laparotomy. After the surgical procedure, she reported abdominal pain predominantly in the right hypochondrium, colicky, associated with emesis of biliary characteristics. Cholangioresonance report revealed mild intrahepatic bile duct dilatation, and scintigraphy with HIDA scan showed sphincter of Oddi dysfunction. Endoscopic sphincterotomy was performed. The patient was asymptomatic and the sphincter of Oddi dysfunction had resolved at two-year follow-up.

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Author Biographies

Arecio Peñaloza- Ramírez, Fundación Universitaria Ciencias de la Salud

Investigador Asociado- Colciencias. Jefe Programa de Especialización en Gastroenterología y Endoscopia Digestiva – Sociedad de Cirugía de Bogotá. Jefe Servicio de Gastroenterología y Endoscopia Digestiva. Hospital de San José.  

Esteban Coral- Argoty, Fundación Universitaria Ciencias de la Salud

Especialista en Cirugía General. Residente de Gastroenterología y Endoscopia Digestiva. Sociedad de Cirugía de Bogotá

María Castro- Rodriguez, Fundación Universitaria Ciencias de la Salud

Especialista en Medicina Interna, Residente de Gastroenterología y Endoscopia Digestiva. Sociedad de Cirugía de Bogotá

Johann Alvarez- Gil, Fundación Universitaria Ciencias de la Salud

Especialista en Medicina Interna, Residente de Gastroenterología y Endoscopia Digestiva. Sociedad de Cirugía de Bogotá

Pedro Aponte- Ordoñez, Fundación Universitaria Ciencias de la Salud

Especialista en Cirugía General, Gastroenterología y Endoscopia Digestiva. Instructor Asistente Programa de Especialización en Gastroenterología y Endoscopia Digestiva. Sociedad de Cirugía de Bogotá.

References

Avisse C, Flament JB, Delattre JF. Ampulla of Vater. Anatomic, embryologic, and surgical aspects. Surg Clin North Am. 2000;80(1):201-12. https://doi.org/10.1016/s0039-6109(05)70402-3

HAND BH. An anatomical study of the choledochoduodenal area. Br J Surg. 1963;50:486-94. https://doi.org/10.1002/bjs.18005022303

Guelrud M, Mendoza S, Rossiter G, Villegas MI. Sphincter of Oddi manometry in healthy volunteers. Dig Dis Sci. 1990;35(1):38-46. https://doi.org/10.1007/BF01537220

Behar J, Corazziari E, Guelrud M, Hogan W, Sherman S, Toouli J. Functional gallbladder and sphincter of oddi disorders. Gastroenterology. 2006;130(5):1498-509. https://doi.org/10.1053/j.gastro.2005.11.063

Moody F, Poots J. Dysfunction of the ampulla of Vater. En: Braasch J, Tompkins R (editores). Surgical Diseases of the Biliary Tract and Pancreas, multidisciplinary management. St. Louis: Mosby; 1994. p. 334-48.

George J, Baillie J. Biliary and gallbladder dyskinesia. Curr Treat Options Gastroenterol. 2007;10(4):322-7. https://doi.org/10.1007/s11938-007-0075-2

Toouli J. What is sphincter of Oddi dysfunction? Gut. 1989;30(6):753-61. https://doi.org/10.1136/gut.30.6.753

Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funch-Jensen P, Corazziari E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38(9):1569-80. https://doi.org/10.1007/BF01303162

Eversman D, Fogel EL, Rusche M, Sherman S, Lehman GA. Frequency of abnormal pancreatic and biliary sphincter manometry compared with clinical suspicion of sphincter of Oddi dysfunction. Gastrointest Endosc. 1999;50(5):637-41. https://doi.org/10.1016/s0016-5107(99)80011-x

Kaw M, Brodmerkel GJ Jr. ERCP, biliary crystal analysis, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis. Gastrointest Endosc. 2002;55(2):157-62. https://doi.org/10.1067/mge.2002.118944

Hogan WJ, Geenen JE. Biliary dyskinesia. Endoscopy. 1988;20 Suppl 1:179-83. https://doi.org/10.1055/s-2007-1018172

Sherman S, Troiano FP, Hawes RH, O’Connor KW, Lehman GA. Frequency of abnormal sphincter of Oddi manometry compared with the clinical suspicion of sphincter of Oddi dysfunction. Am J Gastroenterol. 1991;86(5):586-90.

Solano J. Disfunción del esfínter de Oddi. En: Aponte D, Cañadas R (editores). Técnicas de endoscopia digestiva. 3.a edición. Bogotá: Asociación Colombiana de Endoscopia Digestiva; 2018. p. 515-9.

Elta G, Cotton P, Carter C, Corraziari E, Pasricha P. Gallbladder and sphincter of Oddi Disorders. En: Drossman D (ed). Rome IV Functional gastrointestinal disorders. 4.a edición. Raleigh: The Rome Foundation; 2016. p. 1117-78.

Madura JA 2nd, Madura JA. Diagnosis and management of sphincter of Oddi dysfunction and pancreas divisum. Surg Clin North Am. 2007;87(6):1417-29, ix. https://doi.org/10.1016/j.suc.2007.08.011

Malik S, Kaushik N, Khalid A, Bauer K, Brody D, Slivka A, McGrath K. EUS yield in evaluating biliary dilatation in patients with normal serum liver enzymes. Dig Dis Sci. 2007;52(2):508-12. https://doi.org/10.1007/s10620-006-9582-6

Fogel EL, Eversman D, Jamidar P, Sherman S, Lehman GA. Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone. Endoscopy. 2002;34(4):280-5. https://doi.org/10.1055/s-2002-23629

Steinberg WM. Controversies in clinical pancreatology: should the sphincter of Oddi be measured in patients with idiopathic recurrent acute pancreatitis, and should sphincterotomy be performed if the pressure is high? Pancreas. 2003;27(2):118-21. https://doi.org/10.1097/00006676-200308000-00002

Calzadilla J, Sanhueza N, Farías S, González F. Pancreatitis recurrente secundaria a disfunción del esfínter de Oddi: presentación de un caso [Recurrent pancreatitis secondary to sphincter of Oddi dysfunction: case report]. Medwave. 2016;16(9):e6585. https://doi.org/10.5867/medwave.2016.09.6585

Madura JA, Madura JA 2nd, Sherman S, Lehman GA. Surgical sphincteroplasty in 446 patients. Arch Surg. 2005;140(5):504-11; discussion 511-3. https://doi.org/10.1001/archsurg.140.5.504

Cicala M, Habib FI, Vavassori P, Pallotta N, Schillaci O, Costamagna G, Guarino MP, Scopinaro F, Fiocca F, Torsoli A, Corazziari E. Outcome of endoscopic sphincterotomy in post cholecystectomy patients with sphincter of Oddi dysfunction as predicted by manometry and quantitative choledochoscintigraphy. Gut. 2002;50(5):665-8. https://doi.org/10.1136/gut.50.5.665

Nardi GL, Acosta JM. Papillitis as a cause of pancreatitis and abdominal pain: role of evocative test, operative pancreatography and histologic evaluation. Ann Surg. 1966;164(4):611-21. https://doi.org/10.1097/00000658-196610000-00008

Piccinni G, Angrisano A, Testini M, Bonomo GM. Diagnosing and treating Sphincter of Oddi dysfunction: a critical literature review and reevaluation. J Clin Gastroenterol. 2004;38(4):350-9. https://doi.org/10.1097/00004836-200404000-00010

Pereira SP, Gillams A, Sgouros SN, Webster GJ, Hatfield AR. Prospective comparison of secretin-stimulated magnetic resonance cholangiopancreatography with manometry in the diagnosis of sphincter of Oddi dysfunction types II and III. Gut. 2007;56(6):809-13. https://doi.org/10.1136/gut.2006.099267

Sharma BC, Agarwal DK, Dhiman RK, Baijal SS, Choudhuri G, Saraswat VA. Bile lithogenicity and gallbladder emptying in patients with microlithiasis: effect of bile acid therapy. Gastroenterology. 1998;115(1):124-8. https://doi.org/10.1016/s0016-5085(98)70373-7

Kunwald P, Drewes AM, Kjaer D, Gravesen FH, McMahon BP, Madácsy L, Funch-Jensen P, Gregersen H. A new distensibility technique to measure sphincter of Oddi function. Neurogastroenterol Motil. 2010;22(9):978-83, e253. https://doi.org/10.1111/j.1365-2982.2010.01531.x

Khuroo MS, Zargar SA, Yattoo GN. Efficacy of nifedipine therapy in patients with sphincter of Oddi dysfunction: a prospective, double-blind, randomized, placebo-controlled, cross over trial. Br J Clin Pharmacol. 1992;33(5):477-85. https://doi.org/10.1111/j.1365-2125.1992.tb04074.x

Sand J, Nordback I, Koskinen M, Matikainen M, Lindholm TS. Nifedipine for suspected type II sphincter of Oddi dyskinesia. Am J Gastroenterol. 1993;88(4):530-5.

Nakeeb A. Sphincter of Oddi dysfunction: how is it diagnosed? How is it classified? How do we treat it medically, endoscopically, and surgically? J Gastrointest Surg. 2013;17(9):1557-8. https://doi.org/10.1007/s11605-013-2280-8

Small AJ, Kozarek RA. Sphincter of Oddi Dysfunction. Gastrointest Endosc Clin N Am. 2015;25(4):749-63. https://doi.org/10.1016/j.giec.2015.06.009

Corazziari E, Cicala M, Scopinaro F, Schillaci O, Habib IF, Pallotta N. Scintigraphic assessment of SO dysfunction. Gut. 2003;52(11):1655-6. https://doi.org/10.1136/gut.52.11.1655

Craig AG, Peter D, Saccone GT, Ziesing P, Wycherley A, Toouli J. Scintigraphy versus manometry in patients with suspected biliary sphincter of Oddi dysfunction. Gut. 2003;52(3):352-7. https://doi.org/10.1136/gut.52.3.352

Sostre S, Kalloo AN, Spiegler EJ, Camargo EE, Wagner HN Jr. A noninvasive test of sphincter of Oddi dysfunction in postcholecystectomy patients: the scintigraphic score. J Nucl Med. 1992;33(6):1216-22.

Corazziari E, Cicala M, Habib FI, Scopinaro F, Fiocca F, Pallotta N, Viscardi A, Vignoni A, Torsoli A. Hepatoduodenal bile transit in cholecystectomized subjects. Relationship with sphincter of Oddi function and diagnostic value. Dig Dis Sci. 1994;39(9):1985-93. https://doi.org/10.1007/BF02088136

Sherman S. What is the role of ERCP in the setting of abdominal pain of pancreatic or biliary origin (suspected sphincter of Oddi dysfunction)? Gastrointest Endosc. 2002;56(6 Suppl):S258-66. https://doi.org/10.1067/mge.2002.129016

Geenen JE, Nash JA. The role of sphincter of Oddi manometry and biliary microscopy in evaluating idiopathic recurrent pancreatitis. Endoscopy. 1998;30(9):A237-41. https://doi.org/10.1055/s-2007-1001447

Petersen BT. Sphincter of Oddi dysfunction, part 2: Evidence-based review of the presentations, with “objective” pancreatic findings (types I and II) and of presumptive type III. Gastrointest Endosc. 2004;59(6):670-87. https://doi.org/10.1016/s0016-5107(04)00297-4

Baillie J. Sphincter of Oddi dysfunction. Curr Gastroenterol Rep. 2010;12(2):130-4. https://doi.org/10.1007/s11894-010-0096-1

Hyun JJ, Kozarek RA. Sphincter of Oddi dysfunction: sphincter of Oddi dysfunction or discordance? What is the state of the art in 2018? Curr Opin Gastroenterol. 2018;34(5):282-287. https://doi.org/10.1097/MOG.0000000000000455

Shah T, Zfass A, Schubert ML. Management of Sphincter of Oddi Dysfunction: Teaching an Old SOD New Tricks? Dig Dis Sci. 2016;61(9):2459-61. https://doi.org/10.1007/s10620-016-4252-9

Wilcox CM. Sphincter of Oddi dysfunction Type III: New studies suggest new approaches are needed. World J Gastroenterol. 2015;21(19):5755-61. https://doi.org/10.3748/wjg.v21.i19.5755

Peñaloza-Ramírez A, Leal-Buitrago C, Rodríguez-Hernández A. Adverse events of ERCP at San José Hospital of Bogotá (Colombia). Rev Esp Enferm Dig. 2009;101(12):837-49. https://doi.org/10.4321/s1130-01082009001200003

Pérez LV. Disfunción del esfínter de Oddi y trastornos biliares funcionales. Revista andaluza de patología digestiva. 2017;40(5):233-42.

Figura 1. CPRNM. Estado poscolecistectomía, dilatación de la vía biliar intrahepática en el lóbulo izquierdo, colédoco de 8 mm

Published

2021-04-21

How to Cite

Peñaloza- Ramírez, A., Coral- Argoty, E., Castro- Rodriguez, M. ., Alvarez- Gil, J., & Aponte- Ordoñez, P. . (2021). Sphincter of Oddi disfunction: Case report. Revista Colombiana De Gastroenterología, 36(Supl. 1), 52–58. https://doi.org/10.22516/25007440.550

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