Cholecysto-choledocholithiasis in a patient with partial situs inversus, right-sided round ligament, and annular pancreas

Abstract

A 46-year-old man with a past history of gastrointestinal bypass operation was admitted to our hospital because of epigastric pain and jaundice. CT showed not only stones in both the gallbladder and common bile duct, but also anatomical anomalies, with the stomach and liver in the normal position, and the horizontal part of the duodenum running from left to right behind the superior mesenteric artery and vein, resulting in partial situs inversus distal to the duodenum. Right-sided round ligament, annular pancreas, and polysplenia were also apparent. The patient was given a diagnosis of cholangitis. We first tried biliary drainage and choledocholithotomy endoscopically, but due to difficulty approaching the papilla of Vater, this proved unsuccessful. We therefore performed cholecystectomy and choledocholithotomy as soon as possible. The gallbladder was on the left side of the round ligament and the cystic duct joined the common bile duct from the left side. No stones were found in the common bile duct, but a retrograde transhepatic biliary drainage (RTBD) tube was placed preparatory to choledocholithotomy for the remaining stones. The postoperative course was uneventful. The RTBD tube was removed 1 month postoperatively.