Successful access to the ampulla for endoscopic retrograde cholangiopancreatography in patients with situs inversus totalis: A case report

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2 Citations (Scopus)

Abstract

Background: Although various endoscopic techniques in situs inversus have been reported, endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus is always challenging even for an experienced endoscopist. We performed ERCP using two different techniques, and compare the merits of each technique. Case presentation: A 74-year-old woman presented with epigastric pain and jaundice for 3 days. Computed tomography revealed diffuse dilatation of the biliary tree, with multiple intrahepatic duct and common bile duct (CBD) stones, in addition to situs inversus totalis. ERCP was performed twice for CBD stone to remove the CBD stones using two techniques. For the first technique used, the patient was placed in a prone position with the endoscopist on the right side of the table. First, the endoscope was rotated 180° counterclockwise in the stomach, and was then shortened by turning 180° the counterclockwise again in the duodenum. For the second technique, we assessed the second portion of the duodenum by following the lesser curvature, while slowly turning the endoscope clockwise. Conclusion: We present an unusual case of biliary stones in a patient with situs inversus who was treated using modified ERCP techniques.

Original languageEnglish
Article number112
JournalBMC Surgery
Volume17
Issue number1
DOIs
Publication statusPublished - 2017 Nov 28

Fingerprint

Situs Inversus
Endoscopic Retrograde Cholangiopancreatography
Common Bile Duct
Endoscopes
Duodenum
Prone Position
Biliary Tract
Jaundice
Dilatation
Stomach
Tomography
Pain

Keywords

  • Choledocholithiasis
  • Endoscopic retrograde cholangiopancreatography
  • Situs inversus

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Successful access to the ampulla for endoscopic retrograde cholangiopancreatography in patients with situs inversus totalis: A case report",
abstract = "Background: Although various endoscopic techniques in situs inversus have been reported, endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus is always challenging even for an experienced endoscopist. We performed ERCP using two different techniques, and compare the merits of each technique. Case presentation: A 74-year-old woman presented with epigastric pain and jaundice for 3 days. Computed tomography revealed diffuse dilatation of the biliary tree, with multiple intrahepatic duct and common bile duct (CBD) stones, in addition to situs inversus totalis. ERCP was performed twice for CBD stone to remove the CBD stones using two techniques. For the first technique used, the patient was placed in a prone position with the endoscopist on the right side of the table. First, the endoscope was rotated 180° counterclockwise in the stomach, and was then shortened by turning 180° the counterclockwise again in the duodenum. For the second technique, we assessed the second portion of the duodenum by following the lesser curvature, while slowly turning the endoscope clockwise. Conclusion: We present an unusual case of biliary stones in a patient with situs inversus who was treated using modified ERCP techniques.",
keywords = "Choledocholithiasis, Endoscopic retrograde cholangiopancreatography, Situs inversus",
author = "Lee, {Jung Min} and Lee, {Jae Min} and Hyun, {Jong Jin} and Choi, {Hyuk Soon} and Eun-Sun Kim and Bora Keum and Jeen, {Yoon Tae} and Hoon-Jai Chun and Lee, {Hong Sik} and Kim, {Chang Duck}",
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AU - Hyun, Jong Jin

AU - Choi, Hyuk Soon

AU - Kim, Eun-Sun

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AU - Chun, Hoon-Jai

AU - Lee, Hong Sik

AU - Kim, Chang Duck

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N2 - Background: Although various endoscopic techniques in situs inversus have been reported, endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus is always challenging even for an experienced endoscopist. We performed ERCP using two different techniques, and compare the merits of each technique. Case presentation: A 74-year-old woman presented with epigastric pain and jaundice for 3 days. Computed tomography revealed diffuse dilatation of the biliary tree, with multiple intrahepatic duct and common bile duct (CBD) stones, in addition to situs inversus totalis. ERCP was performed twice for CBD stone to remove the CBD stones using two techniques. For the first technique used, the patient was placed in a prone position with the endoscopist on the right side of the table. First, the endoscope was rotated 180° counterclockwise in the stomach, and was then shortened by turning 180° the counterclockwise again in the duodenum. For the second technique, we assessed the second portion of the duodenum by following the lesser curvature, while slowly turning the endoscope clockwise. Conclusion: We present an unusual case of biliary stones in a patient with situs inversus who was treated using modified ERCP techniques.

AB - Background: Although various endoscopic techniques in situs inversus have been reported, endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus is always challenging even for an experienced endoscopist. We performed ERCP using two different techniques, and compare the merits of each technique. Case presentation: A 74-year-old woman presented with epigastric pain and jaundice for 3 days. Computed tomography revealed diffuse dilatation of the biliary tree, with multiple intrahepatic duct and common bile duct (CBD) stones, in addition to situs inversus totalis. ERCP was performed twice for CBD stone to remove the CBD stones using two techniques. For the first technique used, the patient was placed in a prone position with the endoscopist on the right side of the table. First, the endoscope was rotated 180° counterclockwise in the stomach, and was then shortened by turning 180° the counterclockwise again in the duodenum. For the second technique, we assessed the second portion of the duodenum by following the lesser curvature, while slowly turning the endoscope clockwise. Conclusion: We present an unusual case of biliary stones in a patient with situs inversus who was treated using modified ERCP techniques.

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KW - Endoscopic retrograde cholangiopancreatography

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