Navigating Mirror Anatomy: Successful Percutaneous Endoscopic Gastrojejunostomy Tube Placement in Situs Inversus

Situs inversus (SI) is a rare congenital laterality disorder characterized by complete mirror-image reversal of the thoracoabdominal organs. Percutaneous endoscopic gastrostomy with jejunal extension is commonly indicated for postpyloric enteral nutrition but has not previously been described in patients with SI. We report a case of successful bedside percutaneous endoscopic gastrojejunostomy (PEGJ) tube placement in a 60-year-old woman with primary ciliary dyskinesia and complete SI following bilateral lung transplantation. Preprocedural imaging confirmed mirror-image anatomy. PEGJ tube placement was performed endoscopically using a gastrostomy tube with jejunal extension and required technical modifications to accommodate the reversed anatomy. We demonstrate that PEGJ tube placement in patients with SI is feasible and safe with appropriate preprocedural planning and adaptive endoscopic techniques. Awareness of the altered anatomy, careful site selection, and flexibility in tube advancement strategies are essential to minimize complications and ensure procedural success.