Endoscopic Nasogallbladder Drainage for Acute Cholecystitis in a Patient With Situs Inversus Totalis: A Case Report

Situs inversus totalis (SIT) is a rare congenital condition characterized by complete mirror-image transposition of the thoracic and abdominal organs. Endoscopic transpapillary gallbladder drainage (ETGBD) can be technically challenging in patients with SIT, and, to our knowledge, has not previously been reported in this anatomical setting. We report a case of successful endoscopic nasogallbladder drainage (ENGBD) for acute cholecystitis in a patient with SIT. A 72-year-old man with SIT presented with fever and left hypochondrial pain. Computed tomography revealed acute calculous cholecystitis and a common bile duct stone. After removal of the common bile duct stone by endoscopic retrograde cholangiopancreatography, a guidewire was advanced across the obstructed segment of the cystic duct into the gallbladder, and a 6-Fr ENGBD tube was successfully placed. The patient improved after drainage and subsequently underwent elective laparoscopic cholecystectomy. This case suggests that ETGBD, including ENGBD, may be feasible in patients with SIT when a stable papillary view and guidewire access to the gallbladder can be achieved.