Abstract
A patient with situs inversus visceralis totalis, and choledocholithiasis underwent ERCP and EPT which resulted in evacuation of a stone in the common bile duct into the duo-denum. The patient, a 53 year-old female, had a history of cholecystectomy for cholelithiasis 6 years ago. She developed an episode of severe epigastralgia, nausea and vomiting in Des, 1977, and then she was admitted to another hospital and received some medications with relief of symptoms. She had again an episode of similar symptoms in June, 1978, and at that time upper GIS revealed pneumobilia, regurgitation of contrast medium into the bile duct and choledo-cholithasis. Consequently she was tranferred to our hospital for the purpose of EPT. After admission, She underwent ERCP and EPT. These procedures were done as follows; the patient being placed on rt-side lying position, endoscope was inserted into the duodenal second portion twisted inversely. Two choledochoduodenal fistulas were observed on the inner posterior wall of the duode-nal bulb. Subsequently the papilla of Vater was easily observed, and ERCP (especially ERC) was easily done. Finaly EPT was successfully done with stone evacuation by basket catheter. Her clinical course after EPT is smooth without any surgical intervention so far.
