Percutaneous biliary intervention for primary sclerosing cholangitis in a patient with situs inversus totalis

Situs inversus totalis is a rare condition that may not cause symptoms and often occurs concomitantly with other congenital anomalies. Special attention must be given to these patients when invasive interventions are required. There are only a few reports concerning percutaneous transhepatic biliary interventions in situs inversus totalis, but technical details were not fully explained. In this report, we attempt to explain the technical details of percutaneous transhepatic cholangiography, percutaneous biliary drainage and percutaneous biliary balloon dilatation in a patient with known primary sclerosing cholangitis and situs inversus totalis. While performing percutaneous biliary interventions in patients with situs inversus totalis, the key point is to use the mirror image of the traditional technique in an imaginary line dissecting the midline of the abdomen.