Successful Peroral Cholangioscopy In A Patient With Situs Inversus Partialis

Situs inversus viscerum is a rare congenital condition in which the organs are reversed to the opposite side [1]. Such altered anatomy can make diagnostic and therapeutic procedures very challenging, especially complex ones such as ERCP. Herein, we present a case report of a successful peroral cholangioscopy in a patient with undetermined biliary stricture and situs inversus partialis, which led to a diagnosis of cholangiocarcinoma. A 62-year-old female patient had previously been admitted to another hospital, reporting severe epigastric pain and jaundice. Biochemical analysis showed a total bilirubin level of 4.9 mg/dl and a gamma-glutamyltransferase of 381 U/L. A contrast-enhancement CT scan revealed a distal biliary stricture. At this point, the patient underwent EUS and ERCP, but biliary cannulation was not successful due to anatomical alterations. The patient was then referred to our hospital to perform an ERCP with cholangioscopy. During ERCP, the duodenoscope was rotated through 180° in D2 to enable visualization of the ampulla, situated on the right side of the duodenum. After a successful biliary cannulation, cholangiography showed a dilated common bile duct and a distal stricture. Cholangioscopy was then performed, showing papillary bile duct epithelium with irregular-non dilated vessels (F3V2) and, in some areas, tortuous, irregular and dilated vessels (F3V3) [2]. Targeted biopsy with dedicated forceps were then collected. After the procedure, we deployed a plastic biliary stent. Histological examination showed biliary duct adenocarcinoma with moderate differentiation and, after a multidisciplinary board, the patient was referred to the surgical unit.

Publication History

Article published online:
27 March 2025

• References

• 1 Fukasawa Y, Takano S, Fukasawa M. et al. Form-Vessel Classification of Cholangioscopy Findings to Diagnose Biliary Tract Carcinoma's Superficial Spread Int J Mol Sci. 2020
• 2 Claydon M, McLaughlin S.. Gastrointestinal: situs inversus viscerum. J Gastroenterol Hepatol 2002; 17: 1329