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FRANCIS J. SCHOLZ, MD

Arch Surg. 1975;110(1):17.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

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 . . . [Full Text PDF of this Article]

Author Affiliations
Department of Radiology Peter Bent Brigham Hospital 721 Huntington Ave Boston, MA 02115

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