Shimoda Fumiko, Satoh Akihiko, Asonuma Sho, Umemura Ken, Shimosegawa Tooru
Department of Gastroenterology, South Miyagi Medical Center, 38-1 Aza-Nishi, Ohgawara, Miyagi, 989-1253, Japan.
Clin J Gastroenterol. 2021 Feb;14(1):309-313. doi: 10.1007/s12328-020-01198-1. Epub 2020 Aug 9.
Situs inversus totalis (SIT) is a rare congenital anomaly in which all viscera are transposed to the opposite side of the body. This uncommon anatomy causes technical difficulties in endoscopic treatment. A 98-year-old woman with SIT was admitted to our hospital complaining of upper abdominal pain and fever. Blood examinations and findings of abdominal computed tomography imaging confirmed the diagnosis of acute pancreatitis and cholangitis associated with biliary stones. After recovering from pancreatitis and cholangitis with conservative treatment, she underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) to remove the common bile duct (CBD) stones. The patient and the endoscopist were positioned in the usual ERCP position, and the scope was inserted into the duodenum with an approach in the direction opposite to the routine practice. Biliary cannulation was performed in the direction of 1 o'clock, and the cholangiography showed remarkably dilated CBD filled with numerous stones. Endoscopic papillary large balloon dilation was performed, and the CBD stones were successfully removed. There were no complications, such as bleeding, pancreatitis, or perforation. Over 3 years of follow-up, she had no recurrence of cholangitis or pancreatitis.
全内脏转位（SIT）是一种罕见的先天性异常，其中所有内脏都移位到身体的对侧。这种不常见的解剖结构给内镜治疗带来了技术困难。一名98岁的全内脏转位女性因上腹部疼痛和发热入院。血液检查和腹部计算机断层扫描成像结果证实诊断为与胆结石相关的急性胰腺炎和胆管炎。在通过保守治疗从胰腺炎和胆管炎恢复后，她接受了治疗性内镜逆行胰胆管造影（ERCP）以清除胆总管（CBD）结石。患者和内镜医师处于常规ERCP体位，并且内镜以与常规操作相反的方向插入十二指肠。在1点钟方向进行胆管插管，胆管造影显示胆总管明显扩张，充满大量结石。进行了内镜乳头大球囊扩张，成功清除了胆总管结石。没有出血、胰腺炎或穿孔等并发症。经过3年多的随访，她没有胆管炎或胰腺炎复发。
