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Previous cholecystectomy and choledochal sphincter spasm after morphine sedation

From the Department of Anaesthesia and Intensive Care, Prince of Wales Hospital and Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, PRC.

Address correspondence to: Dr. Anthony Ho, Phone: 852-2632-2735; Fax: 852-2637-2422; E-mail: hoamh{at}hotmail.com

Purpose: To describe a patient with probable choledochal sphincter spasm after preoperative morphine, and to suggest a history of cholecystectomy as a predisposing factor.

Clinical features: A 60 yr old man for femoral-popliteal artery bypass grafting developed right upper quadrant abdominal pain after preoperative morphine and scopolamine. He had a previous cholecystectomy. His pain was relieved with naloxone.

Conclusion: Choledochal sphincter spasm should be part of a differential diagnosis in right upper quadrant pain after sedative doses of morphine, especially if there is a previous cholecystectomy.