Journal of Rawalpindi Medical College | 2026
Authors: Sumera Mushtaq C.; Murtaza G.; Fatima K.; Kazmi K.H.; Ulhaq H.; Hussain T.
DOI: 10.37939/jrmc.v30i1.3073
Journal: Journal of Rawalpindi Medical College
Year: 2026
Publisher: Rawalpindi Medical University
Document Type: Article
Open Access: All Open Access; Gold Open Access
Cited by: 0
ERCP is an invasive procedure for removing common bile duct and pancreatic stones, and the instrument is specially designed for the normal anatomy of intra-abdominal organs. We describe a case in which CBD stones were removed by ERCP in a patient with total situs inversus. ERCP is a challenging procedure, most of the time, even with normal anatomical structures, and is more difficult or impossible with total situs inversus. CBD was assessed as very difficult by an experienced gastroenterologist, and the stones were successfully removed. ERCP was performed by placing the patient in the prone position with the gastroenterologist standing on the normal left side of the table. The duodenoscope was first rotated 180° counterclockwise in the stomach and then shortened by rotating the scope again to 180° clockwise in the duodenum. For the second technique, we assessed the second portion of the duodenum by following the lesser curvature while slowly turning the endoscope clockwise. Papillotomy was performed in a complicated manner, and a stent was successfully placed in the CBD with a free flow of bile. © 2026, Rawalpindi Medical University. All rights reserved.
Choledocholithiasis; Endoscopic retrograde cholangiopancreatography (ERCP); Situs inversus totalis