Gut and Liver 2010; 4(1): 110-113 https://doi.org/10.5009/gnl.2010.4.1.110 Endoscopic Removal of a Bile-Duct Stone Using Sphincterotomy and a Large-Balloon Dilator in a Patient with Situs Inversus Totalis
Author Information
Jin Ho Lee, Dae Hwan Kang, Jong Hwan Park, Min Dae Kim, Ki Tae Yoon, Cheol Woong Choi, Hyung Wook Kim, and Mong Cho
Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Yangsan, Korea

Dae Hwan Kang
© The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. All rights reserved.

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. (Gut Liver 2010;4:110-113)
Keywords: Situs inversus totalis; Endoscopic sphincterotomy; Large-balloon dilator; Bile-duct stone
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. (Gut Liver 2010;4:110-113)
Keywords: Situs inversus totalis; Endoscopic sphincterotomy; Large-balloon dilator; Bile-duct stone
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