Situs inversus totalis (SIT) is a rare congenital condition where thoracic and abdominal organs are arranged as a mirror image of normal anatomy. Albeit often asymptomatic, it can complicate procedures such as endoscopic retrograde cholangiopancreatography (ERCP) due to reversed internal orientation. We present the case of a 52-year-old man with SIT who came to the hospital with upper abdominal pain, jaundice, and pruritus, and imaging revealed a stone in the distal common bile duct. ERCP was performed in the standard left lateral position, but the scope advancement was challenging, whereby a 360° rotation was required to align with the ampulla, which appeared in mirror position. After successfully completing cannulation and wide sphincterotomy, a single stone was removed using balloon extraction. The patient recovered without complications. This case highlights how careful technique and scope manipulation can overcome anatomical challenges in SIT without needing major changes in standard ERCP protocol.
Alotiabi et al. (Fri,) studied this question.