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ERCP in total situs viscerum inversus.

F Fiocca¹, G Donatelli, V Ceci

¹Department of Emergency and Urgency, Policlinico Umberto I, University, 'La Sapienza', Rome, Italy.

Case Reports in Gastroenterology

|April 15, 2011

Summary

This case report details a successful endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stone extraction in a patient with situs viscerum inversus. The procedure was performed conventionally, demonstrating feasibility despite anatomical variations.

Keywords:

Bile duct stones ERCP Endoscopic sphincterotomy Total situs viscerum inversus

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Area of Science:

Gastroenterology
Medical Imaging
Surgical Procedures

Background:

Situs viscerum inversus is a rare congenital condition where major visceral organs are mirrored.
Patients with situs viscerum inversus may present with complex gastrointestinal issues requiring specialized interventions.
Cholecystectomy and common bile duct stones are common conditions, but their management in situs inversus poses unique challenges.

Observation:

A 69-year-old female with situs viscerum inversus and a history of cholecystectomy presented with jaundice and left upper quadrant pain.
Imaging revealed dilated intra- and extrahepatic ducts with a 13 mm peripapillary stone.
Elevated neutrophils and conjugated bilirubin indicated biliary obstruction.

Findings:

Endoscopic retrograde cholangiopancreatography (ERCP) successfully identified and extracted a common bile duct stone.
The ERCP was performed in the conventional manner with the patient prone and the endoscopist positioned to the right.
Sphincterotomy was performed successfully as part of the procedure.

Implications:

This case demonstrates that ERCP for common bile duct stones can be performed successfully in patients with situs viscerum inversus using conventional techniques.
Experienced endoscopists can adapt standard ERCP procedures to manage biliary pathologies in patients with anatomical variations.
Successful management highlights the importance of adapting techniques rather than solely relying on alternative patient positions or surgical approaches.