Incidence and significance of enterogastric reflux during morphine-augmented cholescintigraphy.
One hundred fourteen patients with suspected acute cholecystitis underwent morphine-augmented cholescintigraphy. The 115 studies were reviewed first to determine the incidence of enterogastric reflux under these conditions. Overall, enterogastric reflux was observed in 85/115 (74%), occurring only after intravenous morphine sulfate in the majority (59%, 50/85). Noted prior to morphine in 41% (35/85), the degree of enterogastric reflux increased noticeably directly following drug administration in over half of these cases. Surgical diagnoses were established in 73/114 (64%) patients as follows: 56 (77%) acute cholecystitis, 15 (20%) chronic cholecystitis, and 2 (3%) another entity (normal gallbladder and tumor encasement). These pathologically proven cases were examined more closely to address the diagnostic significance of enterogastric reflux during morphine-augmented cholescintigraphy. Enterogastric reflux was demonstrated in the majority of not only those with acute cholecystitis (48/56, 86%), but also those with chronic cholecystitis (12/15, 80%). A frequent but nonspecific finding, enterogastric reflux appears to be a pathophysiologic phenomenon that may be enhanced synergistically, at least to some degree, in patients requiring morphine-augmented cholescintigraphy.
Oates
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Department of Radiology, New England Medical Center, Boston, Massachusetts.
Achong
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D000814:Aniline Compounds; D001655:Bile Reflux / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002764:Cholecystitis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging*; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009020:Morphine; D015609:Organotechnetium Compounds; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D009020:Morphine; C034837:technetium Tc 99m mebrofenin; D005998:Glycine