Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5744-5748
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5744
Therapeutic endoscopic retrograde cholangiopancreatography in a patient with situs inversus viscerum
Yi Hu, Hao Zeng, Xiao-Lin Pan, Nong-Hua Lv, Zhi-Jian Liu, Yang Hu
Yi Hu, Hao Zeng, Xiao-Lin Pan, Nong-Hua Lv, Zhi-Jian Liu, Yang Hu, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Hu Y and Hu Y collected the patient’s clinical data; Lv NH designed the study; Liu ZJ performed the endoscopic retrograde cholangiopancreatography procedure; Hu Y and Hu Y searched similar published cases, analyzed the data and wrote the manuscript; Pan XL provided the materials of the study; and Zeng H participated in writing the paper.
Ethics approval: The study was approved by the Ethics Committee of The First Affiliated Hospital of Nanchang University.
Informed consent: (1) This case is presented for medical communication only, not for other purposes; (2) The images in this paper do not disclose the patient’s information; (3) Consent was obtained from the patient for publication of this study.
Conflict-of-interest: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yang Hu, MD, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwai Road, Nanchang 330006, Jiangxi Province, China. hygastro@163.com
Telephone: +86-791-88692705 Fax: +86-791-88623153
Received: November 18, 2014
Peer-review started: November 19, 2014
First decision: December 26, 2014
Revised: January 19, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: May 14, 2015
Processing time: 180 Days and 22.1 Hours
Abstract

Situs inversus viscerum (SIV) is a rare congenital condition characterized by complete transposition of all viscera. This anatomical pathology makes endoscopic retrograde cholangiopancreatography (ERCP) technically difficult. We report a new case of a 70-year-old Chinese male with total SIV who had obstructive jaundice. Magnetic resonance cholangiopancreatography demonstrated a number of stones in the gallbladder and common bile duct (CBD). Therapeutic ERCP was performed to relieve biliary obstruction and remove the CBD stones. This procedure started with the patient in a supine position and the endoscopist at the left side of the table. When the papilla was maintained, the patient was repositioned to a prone position and standard endoscopic sphincterotomy and endoscopic papillary balloon dilatation procedures were conducted. ERCP was performed successfully and relevant complications did not occur in this patient. We also present a review of the literature published between 1985 and 2014 in the PubMed and EMBASE databases. There were eight published cases during this period, with one each from America, Finland, India, Italy, South Korea and Pakistan, and two from Spain. Our case is the first reported in China.

Keywords: Situs inversus; Endoscopic retrograde cholangiopancreatography; Common bile duct; Endoscopic sphincterotomy; Endoscopic papillary balloon dilatation

Core tip: Endoscopic retrograde cholangiopancreatography (ERCP) is widely applied for the diagnosis and treatment of pancreaticobiliary disease. However, this approach can be challenging in cases of anatomical variations. Total situs inversus viscerum (SIV) is a rare condition that involves a 180° reversal of all the visceral positions, which increases the difficulty of ERCP. Endoscopic access to the papilla and subsequent cannulation are difficult in these patients. However, we successfully overcame these difficulties by changing the patient’s positions during the procedure. Standard endoscopic sphincterotomy and endoscopic papillary balloon dilatation procedures were performed with no complications. Herein, we also review several related cases with summary information, key steps and technique information for ERCP in patients with SIV.