title: Endoscopic removal of a bile-duct stone using sphincterotomy and a large-balloon dilator in a patient with situs inversus totalis.
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.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Yangsan, Korea.
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.forename: Jong Hwan
authors.initials: JH
authors.lastname: Park
authors.forename: Min Dae
authors.initials: MD
authors.lastname: Kim
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Yoon
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.forename: Mong
authors.initials: M
authors.lastname: Cho