Endoscopic Retrograde Cholangiopancreatography in Situs Inversus Totalis: A Case of Recurrent Hepatobiliary Stones

Background Situs inversus totalis, a rare congenital anomaly with mirror-image organ arrangement, complicates procedures like endoscopic retrograde cholangiopancreatography (ERCP) due to reversed anatomy, necessitating modified approaches for success.

Case Presentation A 52-year-old male with situs inversus totalis presented with abdominal pain, fever, and jaundice. Six years earlier, he was diagnosed with choledocholithiasis and underwent successful ERCP and stone extraction. Recently, after an asymptomatic period, he again experienced severe pain, jaundice, and fever. MRCP revealed dilated intrahepatic ducts and multiple stones, while cholangiogram showed a common bile duct cutoff at the mid-duct level. ERCP cannulation attempts failed due to the reversed anatomy, with bile and pancreatic ducts positioned in a manner opposite the typical configuration, complicating catheter alignment. Percutaneous transhepatic biliary drainage (PTBD) was then performed, successfully decompressing the biliary system. Further surgery was recommended, but the patient declined due to financial reasons [1] [2] [3].

Conclusion This case highlights the technical difficulties of performing ERCP in situs inversus totalis, where altered anatomy complicates orientation and cannulation, increasing procedural risks. Familiarity with these anatomical variations and adapted techniques are essential for successful outcomes and guiding future interventions in patients with this rare condition.

Publication History

Article published online:
27 March 2025

• References

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