ERCP PERFORMED IN A PATIENT WITH TOTAL SITUS INVERSUS VISCERUM

Situs inversus viscerum is a rare congenital condition characterized by complete transposition of all viscera. Endoscopic exams are often challenging in these patients, namely ERCP.

We present a case of a 63-year-old patient with total situs inversus viscerum that presented with complains of intermittent upper left abdominal pain. Abdominal CT scan showed gallstones in the common bile duct and gallbladder. An ERCP was performed with the patient in a supine position and the endoscopist at the left side of the patient. A side-viewing endoscope was used (Olympus TJF-Q180V). Because of the altered anatomy, papilla was in the right upper quadrant of the image and bile duct cannulation was made toward the direction of “1 o'clock”. Cannulation was performed with a standard sphincterotome and guidewire. Cholangiography showed multiple stones in the gallbladder and filling defects in the distal portion of the common bile duct. Sphincterotomy was preformed towards the “1 o'clock” reference. Several infracentimetric stones were removed with a Dormia basket and a Fogarty balloon. The patient was referenced for a surgical consult for cholecistectomy.

This is a case of successfully treated choledocholithiasis in a patient with total situs inversus viscerum. We present figures and video of imagiological exams and ERCP procedure.