Biliary-type pain from sphincter of Oddi dysfunction is not uncommon after cholecystectomy. An increased basal pressure of sphincter of Oddi manometry establishes the diagnosis and treatment is usually by endoscopic sphincterotomy. Both procedures carry a significant complication rate. A few patients with elevated sphincter pressure do not respond to therapy; the source of their pain may be elsewhere. This case report describes the use of intrasphincteric botulinum toxin injection for the diagnosis of sphincter of Oddi dysfunction in a patient after repeated attempts at manometry had failed. This may provide a safe and easy method of determining whether sphincter of Oddi dysfunction may be the cause of biliary pain in post/cholecystectomy patients and help select patients who would benefit from subsequent sphincter ablation, without the risks of sphincter of Oddi manometry. Prospective studies are first needed.
From the Division of Gastroenterology, Department of Medicine (B.B, T.S., J.B.M.) and Department of Surgery (B.M.), University of Missouri, Columbia, Missouri, U.S.A.
Received November 2, 1998; revision received March 8, 1999; accepted March 17, 1999.
Address correspondence and reprint requests to Dr. Bhaskar Banerjee, Division of Gastroenterology, MA 421, Medical Sciences Building, University of Missouri, Columbia, MO 65203, U.S.A.