To twist or not to twist: a case of ERCP in situs inversus totalis

Duodenoscope combined with laparoscopy in treatment of biliary stones for a patient with situs inversus totalis

“…This is consistent with our experience. [7] Duodenal diverticula is present in up to 25% of patients and rarely cause symptoms, but it may become a challenge in ERCP surgery, especially in patients with SIT due to altered anatomy. [8] We found that papilla identification and cannulation are difficult in SIT patients with periampullary diverticulum.…”

ERCP and EUS technique in situs inversus totalis: preparing for a left-sided plot twist

“…However, the ease of insertion may come with difficulty cannulating the papilla, which usually sits in the 1 to 3 o'clock position. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Another technique involved changing the patient position during the procedure, which brought challenges to the endoscopy and was limited by patient intolerance. 20,21 There are few reports in the literature of successful EUS in patients with SIT.…”

Successful ERCP for management of traumatic pancreatic disruption in a patient with situs inversus

“…In our search, two patients had procedures in surgically altered anatomy for the diagnosis of CBD stone and anastomotic stricture in one patient each (16,20). Of the rest 30 cases, the commonest indication for ERCP in situs inversus was CBD stone (18 patients), malignant biliary obstruction (6 patients), biliary stricture (2 patients) while one patient each had portal biliopathy, ampullary adenoma, chronic calcific pancreatitis and normal CBD (2)(3)(4)(5)(7)(8)10,(12)(13)(14)(15)(17)(18)(19)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). This suggests that pancreatic endotherapy has been done very infrequently.…”