Endoscopic Retrograde Cholangiopancreatography of Pancreatitis Due to Microlithiasis in a Patient with Situs Inversus Totalis: A Case Report and Literature Review

Situs inversus is a rare congenital disorder characterized by transposition of the major thoracic organs and all the visceral organs in the abdomen to the opposite side of the normal place in the body. Herein we present a 73-year-old woman with a history of situs inversus totalis who was referred with the complaints of abdominal pain caused by pancreatitis and large common bile duct due to choledochal sludge. Laboratory tests of serum amylase, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase were 960 IU/L, 207 IU/L, 119 IU/L, and 263 IU/L, respectively. The radiographic evaluation confirmed situs inversus totalis, enlarged liver, and dilatation of the intra- and extrahepatic bile duct. The distal end of the common bile duct (CBD) was smoothly tapered. Endosonography also confirmed CBD microlithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) was done to remove microlithiasis. Our Challenge was on ERCP techniques in the position of the patient and endoscopy team. We believe ERCP can be safely performed in usual position with minor modification.