Torsion of the gallbladder is a rare entity that is difficult to diagnose preoperatively, the principal differential diagnosis being cholecystitis. The condition occurs most often in the elderly. Although its etiology is unknown, the presence of a redundant mesentery is a prerequisite for torsion. Computed tomography, ultrasound, and magnetic resonance cholangiopancreatography can provide important diagnostic clues. Torsion of the gallbladder occurs when it twists axially, with subsequent occlusion of bile or blood flow. Therefore, prompt surgical treatment is necessary in order to prevent necrosis and perforation. In the present study, we report a case of torsion of the gallbladder diagnosed by magnetic resonance cholangiopancreatography. This condition was successfully treated by laparoscopic cholecystectomy.
BackgroundIntracholecystic papillary neoplasm (ICPN) is defined as papillary tumors detected macroscopically in the gallbladder. We report a case of ICPN which exhibited the atypical form like a submucosal tumor.Case presentationA 70-year-old man was admitted to our hospital because of hepatic disorder. Computed tomography and magnetic resonance imaging showed irregular thickening of the wall within the gallbladder fundus. Because the lesion might have been malignant, we performed laparoscopic cholecystectomy and liver bed resection. Macroscopic findings showed the mucosal surface of the tumor was smooth, and its form was similar to that of a submucosal tumor. Histopathological examination revealed papillary tumors within the mass with low-grade dysplasia; therefore, we diagnosed ICPN.ConclusionIn the present case, ICPN was resembling a submucosal tumor macroscopically because the tumors arose into the Rokitansky-Aschoff sinus and the adenomyomatous hyperplasia was merged with the ICPN. It is necessary to consider the possibility of tumor lesions within adenomyomatous hyperplasia.
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