Nonpassage of contrast media into the duodenum may be caused by spasm of the sphincter of Boyden and is a well-recognized diagnostic problem in operative cholangiography. Chessick et al (see pp 53-57) have alerted the surgeon to the possible etiologic role of fentanyl. If fentanyl is found to directly induce or potentiate spasm in a majority of patients, an alternative anesthetic may be advised during biliary surgery.
As Chessick et al also point out, however, there are many variables in operative cholangiography and a number of these might induce spasm. In 56 postcholedochotomy cholangiograms reported by Ginzburg et al,1 no duodenal drainage was seen in 24 (43%), but subsequent postoperative T-tube cholangiography was normal for all of these patients. No mention was made of the anesthetic used. Baker2 has noted a 25% incidence of pseudo-obstruction after common duct instrumentation. Such high incidences of apparent obstruction due to spasm
SCHOLZ FJ. Pseudo-obstruction of the Common Duct in Operative Cholangiography. Arch Surg. 1975;110(1):17. doi:10.1001/archsurg.1975.01360070017001
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