Gut Liver.  2010 Mar;4(1):110-113.

Endoscopic Removal of a Bile-Duct Stone Using Sphincterotomy and a Large-Balloon Dilator in a Patient with Situs Inversus Totalis

• Lee JH
• Kang DH
• Park JH
• Kim MD
• Yoon KT
• Choi CW
• Kim HW
• Cho M

Abstract

A 45-year-old female with known situs inversus totalis presented with colicky pain in the left upper abdominal quadrant. The laboratory parameters showed elevated neutrophils and a bilirubin level of 2 mg/dL. CT confirmed situs inversus totalis and dilatation of the intra- and extrahepatic ducts with a 10-mm common bile duct (CBD) stone and a 10-mm gallstone. She underwent papillary dilatation using a radial expansion balloon after sphincterotomy, after which the CBD stone was removed with a basket and balloon. There were no complications, such as bleeding, pancreatitis, or perforation. It might be reasonable to attempt a "partial" biliary endoscopic sphincterotomy followed by a large-balloon dilator in patients with concomitant distal bile duct, papillary stenosis, or altered anatomy (e.g., periampullary diverticulum, Billroth II anatomy). However, when performing an "adequate" biliary endoscopic sphincterotomy this is technically difficult, or in some cases even impossible, and is associated with a higher risk of complications. This paper further expands on the application of these techniques and shows that a papillary balloon dilatation after endoscopic sphincterotomy is a safe, easy, and effective technique for removing bile-duct stones in a patient with situs inversus totalis.

Keyword

Situs inversus totalis; Endoscopic sphincterotomy; Large-balloon dilator; Bile-duct stone

MeSH Terms

Bile Ducts
Bilirubin
Common Bile Duct
Constriction, Pathologic
Dilatation
Diverticulum
Female
Gallstones
Gastroenterostomy
Hemorrhage
Humans
Middle Aged
Neutrophils
Pancreatitis
Situs Inversus
Sphincterotomy, Endoscopic
Abdominal Pain
Bilirubin