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OBSCURE DIAGNOSIS CLINICAL


Key points


• Sphincter of Oddi dysfunction is a syndrome of pain, biochemical abnormality and duct dilatation caused by abnormal function of the sphincter of Oddi. • Consider SOD in patients who continue to suffer pain post cholecystectomy or who have recurrent unexplained pancreatic pain. • SOD may result from stenosis or dysmotility of the sphincter. • There are two forms: biliary and pancreatic. • Treatment is surgical and is best carried out in tertiary centres.


Sphincter of Oddi dysfunction


Our series of uncommon conditions continues, with consultant surgeon Mr Satya Bhattacharya discussing sphincter of Oddi dysfunction


Most clinicians at some point encounter a patient who has had a cholecystectomy, but has continued to suffer from biliary type pain, or a patient who keeps suffering from bouts of pancreatic inflammation and pain for which no obvious cause can be found. These are the situations where one might think of sphincter of Oddi dysfunction (SOD). SOD is a clinical syndrome in which pain, biochemical abnormalities and dilatation of the bile duct or pancreatic duct are attributed to abnormal function of the sphincter of Oddi.1


The bile duct and the pancreatic duct come together in the pancreatic head,


and run together briefly before opening into the second part of the duodenum, at the ampulla of Vater. This opening is encircled by a sphincter, described by Ruggero Oddi in 1887 when he was still a student.2 This controls the flow of bile and pancreatic juice into the duodenum and prevents reflux of duodenal content into the bile duct and pancreatic duct. The sphincter is 6-10mm long and lies within the duodenal wall. A part of it encircles the common channel, and then there are separate biliary and pancreatic components.


In most other mammals, the bile duct and pancreatic duct have separate


openings into the duodenum. The one other animal that has a sphincter anatomy very similar to that of humans is the Australian possum.


Types and causes SOD may result from stenosis of the sphincter, or from dysmotility. Scarring or stenosis of the sphincter can result from the passage of stones, pancreatitis or previous endoscopic sphincterotomy. The real incidence of SOD is not known, with females affected more than men. There are two clinical types of SOD.


Biliary-type SOD is characterised by biliary pain, which may be


► Pulse February 2016 63


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