Removal of Choledocholith by Endoscopic Retrograde Cholangiopancreatography in a Situs Invsersus Patient

Abstract

Situs inversus is an extremely rare autosomal recessive disease with left-right inversion of internal organs. It carries technical difficulties in diagnostic or therapeutic procedures. There have been a few case reports on stone extraction by ERCP in situs inversus patients. ERCP techniques in situs inversus can be classified into conventional method and mirror image method. In mirror image method, the procedure is performed with the patient in the right lateral decubitus position and the endoscopist on the patient's left side. Until now, there is no consensus about which method is better. Herein, we report an unusual case of choledocholithiasis in a patient with situs inversus who underwent ERCP for stone extraction by both conventional method and mirror image method.

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

“…Although widely used in patients with biliary tract disease, ERCP procedures are challenging in the presence of anatomical abnormalities and even a skilled endoscopist can encounter technical difficulties when performing ERCP in patients with situs inversus. There have been only a few reports on ERCP in patients with situs inversus [ 2 – 6 ].…”

“…Situs inversus is a very rare anomaly in which the internal organs are reversed, as if in a mirror image of their normal position [ 1 ]. The incidence of this autosomal recessive condition is approximately 1 in 20,000 [ 2 ]. The anatomy of the left and right sides is reversed; hence, it is more difficult to perform endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy in patients with situs inversus than in normal patients [ 3 , 4 ].…”