Morphine induced sphincter of Oddi dysfunction

Case contributed by Dr Jayanth Keshavamurthy

Presentation

During a CT scan performed for microhaematuria, incidental dilation of intrahepatic biliary ducts, CBD and pancreatic duct are seen. Normal LFTs.

Patient Data

Age: 70 years
Gender: Male

CT showing dilated intrahepatic ducts, CBD, and pancreatic duct. "Double duct sign". No gallstones or signs of pancreatitis. No evidence of cholecystitis or pancreatitis.

MRI and MRCP confirm the CT findings.  No mass identified or filling defect to suggest choledocholithiasis or mass as an etiology for the dilated biliary tree. A radioisotope scan ordered for confirmation.

Nuclear medicine

Hepatobiliary scan confirms delayed excretion of tracer likely from sphincter of Oddi dysfunction. The CBD is dilated.

Case Discussion

Review of the patient's chart shows no abnormal laboratory tests, but only incidental findings. He has been on high dose morphine for pain for 10 years. This is the likely cause for the radiological findings and no further workup is needed.

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Case information

rID: 72027
Published: 4th Nov 2019
Last edited: 12th Nov 2019
Inclusion in quiz mode: Included
Institution: Augusta University

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