ERCP extraction of stones in situs inversus patients; state-of-the-art techniques

Situs inversus totalis (SIT) is a rare congenital disease that causes mirror transposition of the abdomino-thoracic structures. When such patients develop pathologies related to the bile duct, most commonly choledocholithiasis, the optimal diagnostic process can be hampered by the rarity of such a p...

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Main Authors: Deniz Gunsahin, Madalina Ilie, Oana Plotogea, Dan Nicolae Paduraru, Alexandra Bolocan, Octavian Andronic, Florentina Musat, Vlad Baleanu, Dragos Davitoiu, Mihai Pahomeanu, Bogdan Dumbrava, Vlad Enciu, Alexandru Constantinescu
Format: Article
Language:English
Published: MDPI AG 2024-04-01
Series:Journal of Mind and Medical Sciences
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Online Access:https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1446&context=jmms
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author Deniz Gunsahin
Madalina Ilie
Oana Plotogea
Dan Nicolae Paduraru
Alexandra Bolocan
Octavian Andronic
Florentina Musat
Vlad Baleanu
Dragos Davitoiu
Mihai Pahomeanu
Bogdan Dumbrava
Vlad Enciu
Alexandru Constantinescu
author_facet Deniz Gunsahin
Madalina Ilie
Oana Plotogea
Dan Nicolae Paduraru
Alexandra Bolocan
Octavian Andronic
Florentina Musat
Vlad Baleanu
Dragos Davitoiu
Mihai Pahomeanu
Bogdan Dumbrava
Vlad Enciu
Alexandru Constantinescu
author_sort Deniz Gunsahin
collection DOAJ
description Situs inversus totalis (SIT) is a rare congenital disease that causes mirror transposition of the abdomino-thoracic structures. When such patients develop pathologies related to the bile duct, most commonly choledocholithiasis, the optimal diagnostic process can be hampered by the rarity of such a pathology and the lack of medical information on this topic. Once the diagnosis is established, through endoscopic ultrasound and MRCP, the patient is sent to perform ERCP, which requires tailored approaches for each case. We present the case of a 33-year-old patient who was previously documented with SIT. On admission she presented with abdominal pain and fever that started a week before presentation, so antibiotic therapy was initiated. Imaging investigations revealed intrahepatic gallstones, so she underwent ERCP the next day with the identification of an intrahepatic bile lake containing stones within. Naso-biliary drainage was placed and further 2 ERCP procedures followed, with the insertion of 3 plastic biliary stents. The evolution was favorable, until the complete removal of gallstones and remission of clinical symptoms. The patient was carefully monitored in the following two days and the stents were removed, being later discharged and monitored for a period of 6 months in which no biliary/digestive symptoms were noted.
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publishDate 2024-04-01
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spelling doaj-art-b8178d583a8d4fc0b1db7ed49291f95e2025-08-20T03:22:46ZengMDPI AGJournal of Mind and Medical Sciences2392-76742024-04-0111125626010.22543/2392-7674.1446ERCP extraction of stones in situs inversus patients; state-of-the-art techniquesDeniz Gunsahin0Madalina Ilie1Oana Plotogea2Dan Nicolae Paduraru3Alexandra Bolocan4Octavian Andronic5Florentina Musat6Vlad Baleanu7Dragos Davitoiu8Mihai Pahomeanu9Bogdan Dumbrava10Vlad Enciu11Alexandru Constantinescu12Carol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaCarol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaCarol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaCarol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaCarol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaCarol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaCarol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaCarol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaCarol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaCarol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaSaint John’s Emergency Hospital, Department of Gastroenterology, Bucharest, RomaniaCarol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaCarol Davila University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, RomaniaSitus inversus totalis (SIT) is a rare congenital disease that causes mirror transposition of the abdomino-thoracic structures. When such patients develop pathologies related to the bile duct, most commonly choledocholithiasis, the optimal diagnostic process can be hampered by the rarity of such a pathology and the lack of medical information on this topic. Once the diagnosis is established, through endoscopic ultrasound and MRCP, the patient is sent to perform ERCP, which requires tailored approaches for each case. We present the case of a 33-year-old patient who was previously documented with SIT. On admission she presented with abdominal pain and fever that started a week before presentation, so antibiotic therapy was initiated. Imaging investigations revealed intrahepatic gallstones, so she underwent ERCP the next day with the identification of an intrahepatic bile lake containing stones within. Naso-biliary drainage was placed and further 2 ERCP procedures followed, with the insertion of 3 plastic biliary stents. The evolution was favorable, until the complete removal of gallstones and remission of clinical symptoms. The patient was carefully monitored in the following two days and the stents were removed, being later discharged and monitored for a period of 6 months in which no biliary/digestive symptoms were noted.https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1446&context=jmmsercp techniquesstone extractionsitus inversus patientsendoscopysurgerygastroenterology
spellingShingle Deniz Gunsahin
Madalina Ilie
Oana Plotogea
Dan Nicolae Paduraru
Alexandra Bolocan
Octavian Andronic
Florentina Musat
Vlad Baleanu
Dragos Davitoiu
Mihai Pahomeanu
Bogdan Dumbrava
Vlad Enciu
Alexandru Constantinescu
ERCP extraction of stones in situs inversus patients; state-of-the-art techniques
Journal of Mind and Medical Sciences
ercp techniques
stone extraction
situs inversus patients
endoscopy
surgery
gastroenterology
title ERCP extraction of stones in situs inversus patients; state-of-the-art techniques
title_full ERCP extraction of stones in situs inversus patients; state-of-the-art techniques
title_fullStr ERCP extraction of stones in situs inversus patients; state-of-the-art techniques
title_full_unstemmed ERCP extraction of stones in situs inversus patients; state-of-the-art techniques
title_short ERCP extraction of stones in situs inversus patients; state-of-the-art techniques
title_sort ercp extraction of stones in situs inversus patients state of the art techniques
topic ercp techniques
stone extraction
situs inversus patients
endoscopy
surgery
gastroenterology
url https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1446&context=jmms
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