ERCP extraction of stones in situs inversus patients; state-of-the-art techniques

Situs inversus totalis (SIT) is a rare congenital disease that causes mirror transposition of the abdomino-thoracic structures. When such patients develop pathologies related to the bile duct, most commonly choledocholithiasis, the optimal diagnostic process can be hampered by the rarity of such a p...

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Published inJournal of Mind and Medical Sciences Vol. 11; no. 1; pp. 256 - 260
Main Authors Gunsahin, Deniz, Ilie, Madalina, Plotogea, Oana, Paduraru, Dan Nicolae, Bolocan, Alexandra, Andronic, Octavian, Musat, Florentina, Baleanu, Vlad, Davitoiu, Dragos, Pahomeanu, Mihai, Dumbrava, Bogdan, Enciu, Vlad, Constantinescu, Alexandru
Format Journal Article
LanguageEnglish
Published The Lutheran University Association, Inc., dba Valparaiso University 01.04.2024
Ion Motofei, Carol Davila University
Subjects
Care and treatment
Endoscopic retrograde cholangiopancreatography
endoscopy
ercp techniques
Gallstones
gastroenterology
Methods
situs inversus patients
stone extraction
surgery
Romania
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Summary:Situs inversus totalis (SIT) is a rare congenital disease that causes mirror transposition of the abdomino-thoracic structures. When such patients develop pathologies related to the bile duct, most commonly choledocholithiasis, the optimal diagnostic process can be hampered by the rarity of such a pathology and the lack of medical information on this topic. Once the diagnosis is established, through endoscopic ultrasound and MRCP, the patient is sent to perform ERCP, which requires tailored approaches for each case. We present the case of a 33-year-old patient who was previously documented with SIT. On admission she presented with abdominal pain and fever that started a week before presentation, so antibiotic therapy was initiated. Imaging investigations revealed intrahepatic gallstones, so she underwent ERCP the next day with the identification of an intrahepatic bile lake containing stones within. Nasobiliary drainage was placed and further 2 ERCP procedures followed, with the insertion of 3 plastic biliary stents. The evolution was favorable, until the complete removal of gallstones and remission of clinical symptoms. The patient was carefully monitored in the following two days and the stents were removed, being later discharged and monitored for a period of 6 months in which no biliary/digestive symptoms were noted. Keywords: ERCP techniques, stone extraction, situs inversus patients, endoscopy, surgery, gastroenterology
ISSN:2392-7674
2392-7674
DOI:10.22543/2392-7674.1446