The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e1 

ERCP in Patient with Situs Inversus Totalis 
David Farrow 1*, Bryanna Jay1, Ajit Ramadugu1, Yaseen Alastal1 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614

*Corresponding author: david.farrow@utoledo.edu

Published: 05 May 2023 

Introduction: Situs inversus (SI) is a congenital anomaly resulting in transposition of thoracic and 
abdominal organs.  This case details a patient found to have situs inversus totalis (SIT) while being 
evaluated for abdominal pain and ultimately requiring ERCP for choledocholithiasis.     

Case Description/Methods:  An 89-year-old male presented with a history of epigastric abdominal pain 
for one month associated with nausea and non-bloody, non-bilious vomiting. The patient was found to 
have elevated lipase and a CT abdomen showed an obstructing stone at the ampulla accompanied by 
inflammatory changes consistent with pancreatitis and situs inversus totalis. ERCP was indicated for 
choledocholithiasis and was subsequently performed. The side-viewing duodenoscope was advanced 
into the stomach, and a slight clockwise rotation of the scope was needed to advance towards the 
antrum, subsequently the scope was advanced in the long position into the first and second part of the 
duodenum and maintained in the long position. The major papilla was visualized in the upper right 
quadrant of the screen and noted to be bulging, and deep biliary cannulation was difficult due to 
anatomical variation and bulging papilla. A pancreatic duct stent was placed first to aid in biliary 
cannulation and subsequently biliary cannulation was achieved with biliary sphincterotomy and balloon 
sweep performed. 

Discussion: SI is found in approximately 1 in 10,000 which can obscure the diagnosis of abdominal 
pathology.  In our case SIT was noted on CT along with the culprit stone. In such patients careful 
planning to minimize adverse events and maximize success is essential. 

https://dx.doi.org/10.46570/utjms.vol11-2023-666 

https://dx.doi.org/10.46570/utjms.vol11-2023-666
mailto:david.farrow@utoledo.edu