Situs inversus totalis is a rare congenital abnormality characterized by a mirror-image transposition of both the abdominal and the thoracic organs. While this anomaly is known since the ancient times, practicing doctors do not have much experience with it. Laterality is established early in development, and any failure in that process might lead to a wide variety of disorders which may be partial or complete. Situs solitus describes the normal anatomy, situs inversus is the complete reversal, and situs ambiguous is used for any other abnormality of left-right development. Sidedness is regulated by genes: over 100 genes have been linked to laterality defects. Frequency of situs inversus is 1:10,000 and is more frequent in males: 1.5:1. Advanced imaging modalities can be used to assess fine anatomical details, which play a crucial role in these cases to plan radiologic or surgical interventions. Percutaneous biliary procedures, portal vein embolization are really challenging procedures in SIT patients due to the mirror effect. As most surgeons are right-handed, SIT operations can cause difficulties: handling the instruments with their left hand or the pedals with their left foot can be uncomfortable Organ, especially liver transplantation represents an extraordinary surgical challenge. Solutions to overcome the anatomic differences include the use of segment or reduced size graft with rotation, modified piggy-back technique, side to-side caval anastomosis, and vascular conduit. Because of its rarity and special nature, surgical patients with situs inversus may require more flexibility and creativity from the surgical team.

Background: Situs inversus totalis is a rare anatomical variation of both the thoracic and the abdominal organs. Common bile duct strictures can be caused by malignant and benign diseases as well. 7–18% of the latter ones are 'malignant masquerade’ cases, as pre-operative differentiation is difficult. Case presentation: We present the case of a 68y male patient with known situs inversus totalis and a recent onset of obstructive jaundice caused by a malignant behaving common bile duct stricture. Technically difficult endoscopic retrograde cholangiopancreatography, brush cytology, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and percutaneous transhepatic drainage with stent implantation were performed for proper diagnosis. Cholecystectomy, common bile duct resection with hilar lymphadenectomy, and hepatico-jejunostomy have been performed following multidisciplinary consultation. The final histology report did not confirm any clear malignancy, the patient is doing well. Conclusion: In situs inversus patients, both diagnostic and therapeutic procedures can lead to various difficulties. Benign biliary strictures are frequently misdiagnosed preoperatively as cholangiocellular carcinoma. Surgery is usually unavoidable, involving a significant risk of complications. The co-existence of these two difficult diagnostic and therapeutic features made our case challenging.

We present a case demonstrating the potential of radioembolization with Ho-166-labelled microparticles as an effective bridging therapy for hepatocellular carcinoma (HCC) in a 70-year-old male patient with liver cirrhosis awaiting liver transplantation. The patient received a calculated dose of 3 GBq of Ho-166 microspheres, which were selectively administered intra-arterially to the target area during the radioembolization procedure. Post-treatment dosimetry revealed an average tumor absorbed dose of 332 Gy. Contrast-enhanced CT scan performed one month later revealed a necrotic, non-enhancing area at the tumor site, indicating a complete response. The patient successfully underwent liver transplantation 2.5 months after radioembolization. This case suggests that Ho-166 radioembolization is a promising locoregional therapy for HCC, particularly for patients requiring a bridging approach to transplantation.

We report a case of a female patient in her 40s who presented with right upper quadrant pain and abdominal discomfort. Surgical removal was not possible due to the location of the lesion. Between 2021 and 2022, the patient had four additional sessions of conventional transarterial embolization (TAE) with Lipiodol, but none succeeded in sufficiently reducing the hemangioma's size or permanently improving the symptoms. In November 2022, we used transarterial chemoembolization (TACE) with a Bleomycin-Lipiodol emulsion. Follow-up MRI scans showed a gradual reduction in the hemangioma volume, but the symptoms only improved partially. Hence, the patient underwent a second bleomycin TACE embolization in November 2023. By August 2024, control showed a total volume reduction of 409 cm³ (56%) and significant symptom improvement. This case demonstrates that Bleomycin-Lipiodol TACE can effectively reduce the size of giant liver hemangiomas, even after the failure of other interventional therapies.