Abstract
BACKGROUND: Situs inversus viscerum (SIV) is a rare autosomal recessive genetic disorder characterized a complete mirror-image organ reversal in the thoracic and abdominal cavities. Its low incidence presents considerable challenges in clinical diagnosis and treatment, especially concerning gastrointestinal endoscopic procedures. CASE SUMMARY: Herein, we report a case of an 80-year-old male with choledocholithiasis and acute obstructive empyematous cholangitis. Imaging revealed total visceral inversion in the patient. Endoscopic retrograde cholangiopancreatography (ERCP) was successfully performed to remove the stones, resulting to substantial relief of clinical symptoms and gradual improvement of the patient's condition, leading to successful recovery and discharge. CONCLUSION: Therapeutic ERCP is a safe and effective surgical option for patients with SIV. The main focus for successful ERCP in patients with SIV includes positioning adjustments during the surgical process and using the dual-guidewire technique for biliary cannulation.