Successful endoscopic drainage of malignant obstructive jaundice in patients with situs inversus totalis: Two cases report.

Abstract

Introduction and importanceAlthough endoscopic techniques in situs inversus totalis (SIT) have been reported, endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus totalis (SIT) remains difficult to every hepatobiliary surgeon. To investigate the differences of each position, ERCP was used to perform through two different body positions.Case presentationHerein we report a 63-year-old woman presented with epigastric pain for 2 months and jaundice for 7 days and a 51-year-old man with presented jaundice for 7 days. Preoperative examination revealed situs inversus totalis and gallbladder carcinoma with diffuse dilatation of the biliary tree. ERCP was used to perform by using two different body positions. In addition, the ERCP combined with percutaneous transhepatic cholangial drainage (PTCD) was performed in the second patient.Clinical discussionThe different endoscopic approaches are used in different positions, the endoscopist should be familiar with mirror symmetrical anatomy. We argue that the prone position has a higher surgical success rate and ERCP combined with PTCD will be easier in SIT patients.ConclusionERCP in SIT patients is generally safe and it will be easier by combining with PTCD.