Therapeutic endoscopic retrograde cholangiopancreatography in a patient with situs inversus viscerum

Abstract

Situs inversus viscerum (SIV) is a rare congenital condition characterized by complete transposition of all viscera. This anatomical pathology makes endoscopic retrograde cholangiopancreatography (ERCP) technically difficult. We report a new case of a 70-year-old Chinese male with total SIV who had obstructive jaundice. Magnetic resonance cholangiopancreatography demonstrated a number of stones in the gallbladder and common bile duct (CBD). Therapeutic ERCP was performed to relieve biliary obstruction and remove the CBD stones. This procedure started with the patient in a supine position and the endoscopist at the left side of the table. When the papilla was maintained, the patient was repositioned to a prone position and standard endoscopic sphincterotomy and endoscopic papillary balloon dilatation procedures were conducted. ERCP was performed successfully and relevant complications did not occur in this patient. We also present a review of the literature published between 1985 and 2014 in the PubMed and EMBASE databases. There were eight published cases during this period, with one each from America, Finland, India, Italy, South Korea and Pakistan, and two from Spain. Our case is the first reported in China.

Keywords: Common bile duct; Endoscopic papillary balloon dilatation; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy; Situs inversus.

Figure 1

Chest X-ray revealed the tip of the heart was at the right side.

Figure 2

Total situs inversus viscerum in the abdomen and multiple stones in the gallbladder and common bile duct.

Figure 3

Duodenal diverticulum with an ampulla on its edge.

Figure 4

Cholangiography showed dilatation of the common bile duct and stones up to 12 mm with filling defects of the bile duct.

Figure 5

Multiple stones were removed with a Dormia basket.

Figure 6

Cholangiography showed that there were no common bile duct stones.