Journal List > Korean J Gastroenterol > v.66(6) > 1007457

TOOLS
Korean J Gastroenterol. 2015 Dec;66(6):354-358. Korean.
Published online December 22, 2015.  https://doi.org/10.4166/kjg.2015.66.6.354
Copyright © 2015 The Korean Society of Gastroenterology
Removal of Choledocholith by Endoscopic Retrograde Cholangiopancreatography in a Situs Invsersus Patient
Seong Jae Yeo, Jun Heo, Chang Min Cho, Min Kyu Jung, Soo Young Park, Myung Hi Kim, Sangwon Lee and Nari Yu
Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.

Correspondence to: Jun Heo, Department of Internal Medicine, Kyungpook National University Hospital, Dongdeok-ro 130, Jung-gu, Daegu 41944, Korea. Tel: +82-53-200-5505, Fax: +82-53-426-2046, Email: hero797@hanmail.net
Received May 24, 2015; Revised July 20, 2015; Accepted July 28, 2015.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Situs inversus is an extremely rare autosomal recessive disease with left-right inversion of internal organs. It carries technical difficulties in diagnostic or therapeutic procedures. There have been a few case reports on stone extraction by ERCP in situs inversus patients. ERCP techniques in situs inversus can be classified into conventional method and mirror image method. In mirror image method, the procedure is performed with the patient in the right lateral decubitus position and the endoscopist on the patient's left side. Until now, there is no consensus about which method is better. Herein, we report an unusual case of choledocholithiasis in a patient with situs inversus who underwent ERCP for stone extraction by both conventional method and mirror image method.

Keywords: Situs inversus; Endoscopic retrograde cholangiopancreatography; Choledocholithiasis

Figures


 Fig. 1
Computed tomography scan images. (A) Axial image shows situs inversus with the liver seen on the patient's left side and multiple spleens on the right. (B) Multiple common bile duct stones are well demonstrated on the axial image.
Click for larger image


Fig. 2
Endoscopic and fluoroscopic findings using conventional method. (A) Endoscopic image shows that the papilla is oriented to the right side. (B) Fluoroscopic image obtained during ERCP with the patient in prone position demonstrates several filling defects in the bile duct.
Click for larger image


Fig. 3
First follow up endoscopic and fluoroscopic images using mirror image method. (A) Endoscopic image shows that the papilla is found at its normal location when ERCP is performed using mirror image method. (B) Fluoroscopic image taken during ERCP which was performed using mirror image method.
Click for larger image


Fig. 4
Second follow up endoscopic and fluoroscopic findings using conventional method. (A) Endoscopic image shows that the papilla oriented to the right side. (B) Fluoroscopic image obtained during ERCP with the patient in prone position.
Click for larger image

Tables


 Table 1
Type of Situs Inversus and ERCP Method
Click for larger image

Notes

Financial support:None.

Conflict of interest:None.

References
1. Mayo CW, Rice RG. Situs inversus totalis; a statistical review of data on 76 cases with special reference to disease of the biliary tract. Arch Surg 1949;58:724–730.
2. Moore KL. In: Clinical oriented anatomy. 1st ed. Baltimore, London: William & Wilkins; 1980.
3. Chowdhury A, Chatterjee BK, Das U, Dutta P, Dhali GK, Banerjee PK. ERCP in situs inversus: do we need to turn the other way? Indian J Gastroenterol 1997;16:155–156.
4. Çoban Ş, Yüksel I, Küçükazman M, Başar Ö. Successful ERCP in a patient with situs inversus. Endoscopy 2014;46 Suppl 1 UCTN:E222.
5. Fiocca F, Donatelli G, Ceci V, et al. ERCP in total situs viscerum inversus. Case Rep Gastroenterol 2008;2:116–120.
6. Sheikh I, Heard R, Tombazzi C. Technical factors related to endoscopic retrograde cholangiopancreatography in patients with situs inversus. Gastroenterol Hepatol (N Y) 2014;10:277–278.
7. Yokoyama T, Copeland NG, Jenkins NA, Montgomery CA, Elder FF, Overbeek PA. Reversal of left-right asymmetry: a situs inversus mutation. Science 1993;260:679–682.
8. Winer-Muram HT. Adult presentation of heterotaxic syndromes and related complexes. J Thorac Imaging 1995;10:43–57.
9. Imamura T, Momoi N, Go H, Ogasawara K, Sato M, Hosoya M. Rare case of isolated levocardia with polysplenia including normally structured lung without cardiac anomaly. Congenit Anom (Kyoto) 2011;51:187–190.
10. Hiraoka K, Haratake J, Horie A, Miyagawa T. Bilateral renal dysplasia, pancreatic fibrosis, intrahepatic biliary dysgenesis, and situs inversus totalis in a boy. Hum Pathol 1988;19:871–873.
11. Sadhu S, Jahangir TA, Roy MK. Left-sided gallbladder discovered during laparoscopic cholecystectomy in a patient with dextrocardia. Indian J Surg 2012;74:186–188.
12. Applegate KE, Goske MJ, Pierce G, Murphy D. Situs revisited: imaging of the heterotaxy syndrome. Radiographics 1999;19:837–852. discussion 853-854.
13. Kim SH, Kong ON, Ha JK, et al. A case of endoscopic removal of choledocholithiasis in a patient with situs inversus totalis. Korean J Gastrointest Endosc 2002;24:59–61.
14. García-Fernández FJ, Infantes JM, Torres Y, Mendoza FJ, Alcazar FJ. ERCP in complete situs inversus viscerum using a "mirror image" technique. Endoscopy 2010;42 Suppl 2:E316–E317.
15. de la Serna-Higuera C, Perez-Miranda M, Flores-Cruz G, Gil-Simón P, Caro-Patón A. Endoscopic retrograde cholangiopancreatography in situs inversus partialis. Endoscopy 2010;42 Suppl 2:E98.
16. Lee JH, Kang DH, Park JH, et al. Endoscopic removal of a bile-duct stone using sphincterotomy and a large-balloon dilator in a patient with situs inversus totalis. Gut Liver 2010;4:110–113.
17. Patel KS, Patel JN, Mathur S, Moshenyat Y. To twist or not to twist: a case of ERCP in situs inversus totalis. Endoscopy 2014;46 Suppl 1 UCTN:E304–E305.
18. Kim SB, Kim KH, Kim TN. Successful stone removal by endoscopic retrograde cholangiopancreatography in situs inversus totalis with Billroth-II gastrectomy. Gut Liver 2015;9:118–119.
19. Byun JR, Jahng JH, Song JC, Yu JS, Lee DK. Supine position endoscopic retrograde cholangiopancreatography in a patient with situs ambiguous with polysplenia. Dig Endosc 2010;22:322–324.
TOOLS
Similar articles

A Road Less Traveled: Endoscopic Retrograde Cholangiopancreatography in a Patient with Long-standing Achalasia and Sigmoid Esophagus

Training in Endoscopy: Endoscopic Retrograde Cholangiopancreatography

The Management of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforation

Complete Endoscopic Clearance of Common Bile Duct Stones

Portal cavernography during endoscopic retrograde cholangiopancreatography: from bilhemia to hemobilia