SPHINCTER OF ODDI DYSFUNCTION CAUSED BY AN AMPULLARY NEOPLASM

The case of a 50-year-old man with abdominal pain and abnormal liver t est results is described. Endoscopic retrograde cholangiopancreatograp hy with manometric studies showed biliary dilatation, poor ductal drai nage, and sphincter of Oddi dysfunction. Clinical and radiographic clu es suggested the possibility of an ampullary lesion; a small ampullary adenoma was detected after endoscopic sphincterotomy, and ampullary c arcinoma was found in the operative specimen. Malignancy can cause sph incter dysfunction not only in the esophagus (as pseudoachalasia) but in the ampulla of Vater as well.