ABSTRACT
Situs inversus is a rare congenital disorder characterized by transposition of the major thoracic organs and all the visceral organs in the abdomen to the opposite side of the normal place in the body. Herein we present a 73-year-old woman with a history of situs inversus totalis who was referred with the complaints of abdominal pain caused by pancreatitis and large common bile duct due to choledochal sludge. Laboratory tests of serum amylase, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase were 960 IU/L, 207 IU/L, 119 IU/L, and 263 IU/L, respectively. The radiographic evaluation confirmed situs inversus totalis, enlarged liver, and dilatation of the intra- and extrahepatic bile duct. The distal end of the common bile duct [CBD] was smoothly tapered. Endosonography also confirmed CBD microlithiasis. Endoscopic retrograde cholangiopancreatography [ERCP] was done to remove microlithiasis. Our Challenge was on ERCP techniques in the position of the patient and endoscopy team. We believe ERCP can be safely performed in usual position with minor modification
ABSTRACT
In some studies inflammatory bowel disease [IBD] and celiac disease were considered to be associated and some believe that this association may influence the prognosis of IBD. However, there is a considerable controversy regarding this association. Therefore ,we aimed to assess the association of these two common digestive diseases and evaluate the complications of this association. In this comparative study, 200 patients with ulcerative colitis [UC] and 206 patients with Crohn's disease [CD] were evaluated for celiac disease using relevant diagnostic tests and pathologic studies. Total IgA, IgA tissue transgulaminase antibody and specific IgA anti endomysial antibody were asseyed. In cases of IgA deficiency, total IgG and IgG tissue TG and IgG anti endomyseal Ab were measured. Patients with increased specific IgA and IgG antibodies for celiac disease, underwent endoscopy and 4 standard samples were obtained. Our results were compared with the results of the prevalence study of celiac disease in the general population. Data were analyzed using analytic and descriptive statistics at a significance level of 5%. Among the studied patients, 1 patient with UC had elevated IgA anti tTG antibody and IgA anti-endomysial antibody who underwent endoscopy and celiac was confirmed on pathology. Hence, of the 200 patients with UC, the diagnosis of celiac disease was confirmed in 1 patient [1:200] with no significant difference with the prevalence of celiac disease in the general population [1:166]. However, none of our patients with Crohn's disease had celiac disease [0:206]. We found no significant difference in the prevalence of celiac disease between patients with UC and the general population. Since most of our participants had a mild level of Crohn's activation, none of those with Crohn's disease had celiac disease. Complications of IBD including sclerosing cholangitis, may be more common in patients with concurrent celiac disease. Therefore, it is recommended that celiac disease be considered in patients with severe and complicated IBD