Percutaneous transhepatic biliary drainage after failed endoscopic approach in patients with pancreatic cancer and situs inversus totalis

Giordano, Giuseppe; Bonomo, Stefania; Failla, G.; Luigiano, Carmelo; Caloggero, Simona; Lio, Vincenzo Magnano San

doi:10.1055/s-0034-1390779

Cited by 3 publications

(5 citation statements)

References 5 publications

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“…More complicated ERCP procedures were reported by several published SIT cases, such as repeated mechanical lithotripsy or spyglass-guided laser lithotripsy, or CBDS removal in case of B-II gastrectomy [ 24 – 26 ]. Laparoscopic surgery, or percutaneous drainage with or without rendezvous method were reported to rescue failed ERCP cases [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of ERCP in patients with situs inversus totalis: multicenter case series and literature review

Ding

Wang

et al. 2022

BMC Gastroenterol

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Background Endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus totalis (SIT) is rarely understood due to its rarity. Patient position and endoscope manipulation were the main concerns in published case reports. The aim of this study was to investigate the efficacy and safety of ERCP in SIT patients. Methods Patients with SIT who underwent ERCP were enrolled in nine endoscopic centers in China. ERCP procedural details and complications in SIT patients were retrieved from electronic medical record. The data was retrospectively analyzed. Results From 2011 to 2021, totally 14 patients with SIT undergoing ERCP were identified. The mean age was 56.8 years old and the male–female ratio was 5:2. The main indication for ERCP was common bile duct stones (13/14, 92.9%). All procedure were performed by experienced endoscopists. 21.4% (3/14) of patients were under regular position (prone), while 78.6% under modified position (supine, left or right lateral). Difficult cannulation was occurred in 71.4% (10/14) of patients. The rate of successful cannulation was 85.7% (12/14). Complication occurred in 3 patients (3/14, 21.4%), including 1 bleeding, 1 pneumonia and 1 acute myocardial infarction. No post-pancreatitis or death happened. Compared to patients in modified position, those in prone position had numerically less successful cannulations (66.7% vs. 90.9%) and higher adverse events (33.3% vs. 18.2%). Conclusions ERCP in patient with SIT is challenging even for experienced endoscopists, modified patient positions might have potential benefits concerning more successful cannulations and less complications. More case experiences are need for comprehensive understanding of ERCP in patients with SIT.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of ERCP in patients with situs inversus totalis: multicenter case series and literature review

Ding

Wang

et al. 2022

BMC Gastroenterol

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“…In our search, two patients had procedures in surgically altered anatomy for the diagnosis of CBD stone and anastomotic stricture in one patient each (16,20). Of the rest 30 cases, the commonest indication for ERCP in situs inversus was CBD stone (18 patients), malignant biliary obstruction (6 patients), biliary stricture (2 patients) while one patient each had portal biliopathy, ampullary adenoma, chronic calcific pancreatitis and normal CBD (2)(3)(4)(5)(7)(8)10,(12)(13)(14)(15)(17)(18)(19)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). This suggests that pancreatic endotherapy has been done very infrequently.…”

Section: Discussionmentioning

confidence: 99%

“…ERCP in patients with situs inversus is considered a difficult procedure and has been reported to fail in some cases (21,26,28,32). Various techniques have been described in literature ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

Successful ERCP for management of traumatic pancreatic disruption in a patient with situs inversus

Sharma

Malik

Mandavdhare

et al. 2018

IRDR

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Endoscopic retrograde cholangio-pancreatography (ERCP) is an important tool for treatment of pancreaticobiliary diseases. However, ERCP may be difficult in patients who have altered gastrointestinal anatomy due to congenital or surgical reasons. A 40-year-old male with HIV infection presented with abdominal pain following abdominal trauma. The patient was diagnosed to have traumatic pancreatic injury and underlying situs inversus. The pancreatic fluid collection was drained using radiology guided pigtail placement done for the symptoms of abdominal pain and vomiting. The resulting external pancreatic fistula was successfully managed with ERCP and stenting. The patient improved with disappearance of ascites and resolution of pigtail output which was then removed. We report the technique used for ERCP in this patient. We also review the literature on pancreatic endotherapy in patients with situs inversus. The published literature suggests that with modifications in the standard ERCP technique like mirror image technique, 180 degree turn technique, left lateral technique these patients can be managed successfully.

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“…There are only a few cases reported in the literature when a patient with situs inversus underwent an interventional radiological procedure. [63][64][65][66][67] Gasparrini et al reported a patient with situs inversus totalis who underwent repeated TACE treatments after Fontan surgery. 68 Variant origin of the hepatic artery (from the superior mesenteric artery) further complicated the case.…”

Section: Interventional Radiology (Ir)mentioning

confidence: 99%

“…Giordano et al and Gupta et al described a very similar workflow for PTD in situs inversus totalis patients. 63,65 Similarly to PTD, portal vein embolization (PVE) can also be challenging due to the mirror-effect. So far there is only one reported case of PVE on a situs inversus totalis patient published by Faria et al 66 Balloon-occluded retrograde transvenous obliteration (BRTO) is a minimally invasive treatment for patients with gastric varices.…”

Section: Interventional Radiology (Ir)mentioning

confidence: 99%

Situs Inversus Totalis: A Clinical Review

Eitler¹,

Bibok²,

Telkes³

2022

IJGM

100

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Situs inversus totalis is a rare congenital abnormality characterized by a mirror-image transposition of both the abdominal and the thoracic organs. While this anomaly is known since the ancient times, practicing doctors do not have much experience with it. Laterality is established early in development, and any failure in that process might lead to a wide variety of disorders which may be partial or complete. Situs solitus describes the normal anatomy, situs inversus is the complete reversal, and situs ambiguous is used for any other abnormality of left-right development. Sidedness is regulated by genes: over 100 genes have been linked to laterality defects. Frequency of situs inversus is 1:10,000 and is more frequent in males: 1.5:1. Advanced imaging modalities can be used to assess fine anatomical details, which play a crucial role in these cases to plan radiologic or surgical interventions. Percutaneous biliary procedures, portal vein embolization are really challenging procedures in SIT patients due to the mirror effect. As most surgeons are right-handed, SIT operations can cause difficulties: handling the instruments with their left hand or the pedals with their left foot can be uncomfortable Organ, especially liver transplantation represents an extraordinary surgical challenge. Solutions to overcome the anatomic differences include the use of segment or reduced size graft with rotation, modified piggy-back technique, side to-side caval anastomosis, and vascular conduit. Because of its rarity and special nature, surgical patients with situs inversus may require more flexibility and creativity from the surgical team.

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Percutaneous transhepatic biliary drainage after failed endoscopic approach in patients with pancreatic cancer and situs inversus totalis

Cited by 3 publications

References 5 publications

Efficacy and safety of ERCP in patients with situs inversus totalis: multicenter case series and literature review

Efficacy and safety of ERCP in patients with situs inversus totalis: multicenter case series and literature review

Successful ERCP for management of traumatic pancreatic disruption in a patient with situs inversus

Situs Inversus Totalis: A Clinical Review

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