SHM Converge Scientific Abstract ePoster Gallery-"Phantom Gallbladder Pain": Type I Sphincter of Oddi Dysfunction Unmasked After Cholecystectomy

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This case describes a 61-year-old man who developed recurrent right upper quadrant pain three months after cholecystectomy for biliary dyskinesia. His pain was similar to his preoperative symptoms, sporadic, not meal-related, and occasionally associated with nausea and vomiting. Initial evaluation showed mild leukocytosis and later a marked rise in liver enzymes and GGT. Because of concern for a postoperative bile leak, MRCP and HIDA scan were performed, but both were negative. However, after the HIDA scan he had an acute pain episode with sharp worsening of liver tests, raising suspicion for sphincter of Oddi dysfunction (SOD).<br /><br />SOD is an uncommon but important cause of persistent or recurrent abdominal pain after cholecystectomy. It results from stenosis or abnormal contraction of the sphincter of Oddi, leading to impaired bile flow. The Milwaukee classification divides SOD into three types; type I is considered more likely due to structural obstruction, while types II and III are more functional. Although ERCP with manometry is the diagnostic gold standard, manometry is not always available. When clinical suspicion is high, empiric biliary sphincterotomy is an accepted treatment approach.<br /><br />The patient underwent ERCP the next day, which showed a dilated common bile duct, and he received biliary sphincterotomy. His abdominal pain improved, and he was discharged.<br /><br />This case highlights the importance of maintaining a broad differential diagnosis in patients with post-cholecystectomy pain, especially when liver enzymes are elevated. Post-cholecystectomy complications occur in 10–20% of patients, and SOD accounts for a small subset of these cases. Close collaboration with gastroenterology is essential for diagnosis and definitive treatment.

Asset Subtitle

Marla M. Sagatelian

Meta Tag

Author List Marla M. Sagatelian, Nikesh Kapadia, Robert M. Krahmer

Category Clinical Vignettes

Concept Sphincter of Oddi Dysfunction

Concept Right Upper Quadrant Pain

Concept Biliary Pain

Concept Cholecystectomy

Concept Abdominal Pain

Distinguished Non-Finalist

Presenter Organization University of South Florida

Presenting Author Marla M. Sagatelian

Track Adult

Keywords

sphincter of Oddi dysfunction

post-cholecystectomy pain

biliary dyskinesia

right upper quadrant pain

elevated liver enzymes

MRCP

HIDA scan

ERCP

biliary sphincterotomy

common bile duct dilation

Sphincter of Oddi Dysfunction

Right Upper Quadrant Pain

Biliary Pain

Cholecystectomy

Abdominal Pain