Successful Endoscopic Retrograde Cholangiopancreatography for Management of Choledocholithiasis in a Patient With Situs Inversus Totalis: A Case Report and Literature Review.

Situs inversus totalis is a rare congenital disorder defined by the transposition of all viscera to the opposite side of the body. Because of this anatomical alteration, endoscopic retrograde cholangiopancreatography (ERCP) in such a population is significantly challenging. Herein we report a case of a 50-year-old woman presented with epigastric and left upper quadrant pain. Preoperative examination revealed abnormal liver chemistries, situs inversus totalis, and multiple distal common bile duct stones with intrahepatic and extrahepatic bile duct dilatation on abdominal ultrasound. The patient underwent a successful ERCP to relieve biliary obstruction. It was performed while the patient was placed in a supine position with the endoscopist standing on the left side of the patient. The major emphasis in ERCP is adjusting the patient and endoscopist positions during the procedure. The advantage of the supine position is that the endoscope could easily reach the pyloric ring and, after reaching the duodenum, the papilla could be reached without difficulty.