A case of occult pancreaticobiliary reflux due to endoscopically confirmed relaxation of the Oddi sphincter.
Oddi dysfunction
biliary tract neoplasms
cholecystitis
congenital biliary dilatation
pancreaticobiliary maljunction
Journal
DEN open
ISSN: 2692-4609
Titre abrégé: DEN Open
Pays: Australia
ID NLM: 9918317682706676
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
20
05
2022
revised:
23
07
2022
accepted:
03
08
2022
entrez:
3
10
2022
pubmed:
4
10
2022
medline:
4
10
2022
Statut:
epublish
Résumé
An otherwise healthy 45-year-old woman had been experiencing intermittent right upper abdominal pain for the past 1 year. Computed tomography showed pneumobilia and pancreatic duct emphysema despite a normal duodenal papilla. Magnetic resonance cholangiopancreatography and endoscopic ultrasound confirmed bile duct dilation but without a pancreaticobiliary maljunction. Duodenoscopy detected a slightly sunken, unfixed, and spontaneously enlarged duodenal papilla. During the cholangiogram, the Oddi sphincter was relaxed and the catheter could be easily inserted into the bile duct. Further, no findings suggestive of pancreaticobiliary maljunction were observed, and the contrast medium leaked spontaneously from the duodenal papilla. As biliary amylase level was high, we surmised the occurrence of occult pancreaticobiliary reflux due to relaxation of the Oddi sphincter. However, as there are no guidelines on the management of this condition, we did not offer any treatment. Nevertheless, the patient continued to experience similar symptoms and was retested 1 year later with similar results. As occult pancreaticobiliary reflux was reconfirmed, we suggested that the patient undergo laparoscopic extrahepatic bile duct resection and cholecystectomy, which is the standard treatment for pancreaticobiliary maljunction. Pathological evaluation revealed fibrous thickening of the bile duct wall and chronic cholecystitis, which are typical findings of pancreaticobiliary reflux. Even though pancreaticobiliary reflux is mainly observed in pancreaticobiliary maljunction, it has also been reported in normal patients. Here, we describe a novel mechanism of pancreaticobiliary reflux, namely, a relaxed or defective Oddi sphincter.
Identifiants
pubmed: 36189169
doi: 10.1002/deo2.161
pii: DEO2161
pmc: PMC9511079
doi:
Types de publication
Case Reports
Langues
eng
Pagination
e161Informations de copyright
© 2022 The Authors. DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
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