Opium-related sphincter of Oddi dysfunction causing double duct sign

Abstract

Double duct sign where there is a simultaneous dilatation of both the common bile duct (CBD) and pancreatic duct is usually associated with sinister causes like malignancies of pancreatic head or ampulla. Occasionally, benign causes like chronic pancreatitis or sphincter of Oddi dysfunction (SOD) may cause double duct sign. Chronic opium abuse is a rare cause of the double duct sign, and endoscopic ultrasound (EUS) findings of this rare entity have been occasionally reported. We report about a 54-year-old male with a history of chronic alcohol and opioid abuse evaluated for episodes of abdominal pain and found to have opioid-related SOD and improved with biliary sphincterotomy. EUS was done to rule out malignancy and revealed hypoechoic prominence around terminal CBD suggestive of hypertrophied muscle.

Rare Cause of Sphincter of Oddi Dysfunction and Double Duct Sign

“…EUS is an important investigation to diagnose this condition by ruling out other etiologies such as neoplastic lesions or chronic pancreatitis. 5 Other EUS findings supporting the diagnosis were smooth symmetrical narrowing of ducts at ampulla and symmetrically thickened ampullary muscles. ERCP findings of circumferential thickening of ampullary muscle also supported the diagnosis of SOD.…”

Biliary type-II sphincter of Oddi dysfunction with a pancreatic duct dilation: a case report and review of the literature

“…To our knowledge, no previous cases in the literature have reported the double-duct sign as a result of biliary type II SOD with a pancreatic duct dilation without the presence of pancreatitis. Two cases of double-duct sign were due to opiate-associated sphincter of Oddi dysfunction [ 2 , 3 ]. The double-duct sign usually indicates pancreatic malignancy with a lower prevalence in patients who do not have obstructive jaundice [ 8 ].…”

“…However, benign causes have also been reported to cause a double-duct sign, including chronic pancreatitis and ampullary stenosis [ 1 ]. Only two cases in the literature have described a double-duct sign due to sphincter of Oddi dysfunction (SOD) as the underlying etiology [ 2 , 3 ]. We report the case of a 59-year-old female who presented with abdominal pain and was diagnosed with an unusual cause of the double-duct sign.…”