Navigating endoscopic challenges in situs inversus totalis: strategies for optimal procedure completion and patient safety

Flexible endoscopy is a gold standard diagnostic test for the evaluation of the gastrointestinal tract and an accessible intervention in clinical practice. Completion rates are generally high while perforation rates are low in experienced hands. Situs inversus totalis (SIT) is a rare congenital abnormality that involves the complete transposition of all the viscera. In less-experienced hands, incompletion and perforation rates may increase in patients with SIT due to unfamiliarity with anatomy. The purpose of this case report is to present methods such as reverse manoeuvres to assist in the safe completion of an endoscopy in SIT when technical difficulties arise.  Using a case of a patient in a rural hospital who presented for a colonoscopy who had SIT, we discuss the use of adjuncts, variations in segment specific manoeuvres, traditional positioning and abdominal pressure points in-order to perform a safe and successful endoscopy in a patient with SIT.