Resumo

CASTRO, Denny Javier  e  DE FARIA, Alejandro. Case study of a sphincterotomy to remove stones from the common bile duct cholelithiasis biliary in a patient with total situs inversus. Rev Col Gastroenterol [online]. 2013, vol.28, n.2, pp.146-148. ISSN 0120-9957.

Situs inversus is an autosomal recessive condition characterized by of thoracic and abdominal organs in mirror image locations. It is classified into total and partial situs inversus. There is a complete transposition of thoracic and abdominal organs in total situs inversus while there is partial transposition of one or more organs in partial situs inversus. The incidence of this condition ranges from 0.002% to 1%. Although this entity does not usually affect an individual's longevity, the patient's clinical picture is different than that of other people. Consequently when the condition has not already been diagnosed, an endoscopist or surgeon is likely to be surprised. We report the case of a 38 year old female patient who consulted for pain in the left upper abdominal quadrant. She suffered from biliary colic and had an altered liver profile. Abdominal ultrasound showed transposition of the liver and common bile duct to the upper left abdominal quadrant as well as a dilated common bile duct with gallstones. ERCP (endoscopic retrograde cholangiopancreatography) was requested. Cardiovascular assessment with chest x-ray showed dextrocardia. Abdominal computed tomography corroborated the diagnosis of total situs inversus. An MRCP (Magnetic Resonance Cholangiopancreatogram) showed dilation of the distal common bile duct within which were two stones. An ERCP showed that the papilla was larger on the right and was rotated 180°. A sphincterotomy was performed, and the cholesterol stones were extracted. This case shows the importance of preoperative diagnosis for addressing the bile duct in patients with situs inversus

Palavras-chave : Total situs inversus; choledocholithiasis.

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