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Supine position endoscopic retrograde cholangiopancreatography in a patient with situs ambiguous with polysplenia

Authors
 Jeong Rae Byun  ;  Jae Hoon Jahng  ;  Jae Chun Song  ;  Jeong Sik Yu  ;  Dong Ki Lee 
Citation
 DIGESTIVE ENDOSCOPY, Vol.22(4) : 322-324, 2010 
Journal Title
 DIGESTIVE ENDOSCOPY 
ISSN
 0915-5635 
Issue Date
2010
MeSH
Abnormalities, Multiple/pathology* ; Ampulla of Vater/pathology* ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde* ; Common Bile Duct Neoplasms/diagnostic imaging* ; Common Bile Duct Neoplasms/pathology ; Common Bile Duct Neoplasms/surgery* ; Female ; Humans ; Middle Aged ; Neoplasm Staging ; Positron-Emission Tomography ; Spleen/abnormalities* ; Supine Position ; Tomography, X-Ray Computed
Keywords
endoscopic retrograde cholangiopancreatography (ERCP) ; situs ambiguous with polysplenia ; supine position
Abstract
A 58-year-old woman complained of painless jaundice. The serology showed total bilirubin 10.6 mg/dL with direct bilirubin of 7.0 mg/dL. Abdominal computed tomography (CT) scan disclosed an abnormal arrangement of the abdominal viscera and dilation of the biliary tree. A nearly 1.4 cm-sized periampullary mass was seen. These findings are compatible with situs ambiguous with polysplenia and were suggestive of a periampullary tumor. Due to her unusual anatomical features, the patient underwent an endoscopic retrograde cholangiopancreatography (ERCP) in the supine position instead of in the conventional prone position. ERCP showed that the common bile duct (CBD) diameter was increased to 20 mm. Microscopic findings of the biopsy specimen of papillary mass were compatible with an adenocarcinoma of the ampulla of Vater. The clinical stage was stage IA (T1N0M0). Eight days later, a papillectomy was carried out by endoscopic snare resection. Six months later, follow-up studies, including ERCP, abdominal CT and 18-fluorodeoxyglucose positron emission tomography ((18) -FDG PET)-CT scan, showed no evidence of recurrence. Although the success rate of supine position ERCP may be influenced by the extent of the intestinal malrotation and the position of the duodenum, we conclude that supine position ERCP can be carried out effectively in a patient with situs anomaly.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/j.1443-1661.2010.01024.x/abstract
DOI
10.1111/j.1443-1661.2010.01024.x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Byun, Jeong Rae(변정래)
Yu, Jeong Sik(유정식) ORCID logo https://orcid.org/0000-0002-8171-5838
Lee, Dong Ki(이동기) ORCID logo https://orcid.org/0000-0002-0048-9112
Jahng, Jae Hoon(장재훈)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/101750
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