Successful access to the ampulla for endoscopic retrograde cholangiopancreatography in patients with situs inversus totalis: A case report

Jung Min Lee, Jae Min Lee, Jong Jin Hyun, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen, Hoon Jai Chun, Hong Sik Lee, Chang Duck Kim

    Research output: Contribution to journalArticlepeer-review

    18 Citations (Scopus)

    Abstract

    Background: Although various endoscopic techniques in situs inversus have been reported, endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus is always challenging even for an experienced endoscopist. We performed ERCP using two different techniques, and compare the merits of each technique. Case presentation: A 74-year-old woman presented with epigastric pain and jaundice for 3 days. Computed tomography revealed diffuse dilatation of the biliary tree, with multiple intrahepatic duct and common bile duct (CBD) stones, in addition to situs inversus totalis. ERCP was performed twice for CBD stone to remove the CBD stones using two techniques. For the first technique used, the patient was placed in a prone position with the endoscopist on the right side of the table. First, the endoscope was rotated 180° counterclockwise in the stomach, and was then shortened by turning 180° the counterclockwise again in the duodenum. For the second technique, we assessed the second portion of the duodenum by following the lesser curvature, while slowly turning the endoscope clockwise. Conclusion: We present an unusual case of biliary stones in a patient with situs inversus who was treated using modified ERCP techniques.

    Original languageEnglish
    Article number112
    JournalBMC Surgery
    Volume17
    Issue number1
    DOIs
    Publication statusPublished - 2017 Nov 28

    Bibliographical note

    Publisher Copyright:
    © 2017 The Author(s).

    Keywords

    • Choledocholithiasis
    • Endoscopic retrograde cholangiopancreatography
    • Situs inversus

    ASJC Scopus subject areas

    • Surgery

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