Cancer of bile duct with situs inversus

We present a case of adenocarcinoma of the distal common bile duct in a 68-year-old woman with total situs inversus. Endoscopic retrograde cholangiopancreatography prior to surgery demonstrated segmental obstruction of the distal common bile duct. Obstructive jaundice was observed and the results of liver function studies were abnormal. All biopsy specimens obtained in the operating room were negative. The case met all the criteria of Child and Frey, but at the end of the procedure the tumor was found to involve the superior mesenteric vein, a factor not appreciated during the operative evaluation of the patient. The situs inversus did not produce any technical problems. The patient did not have any surgical complications, but she died 18 months later of the cancer.