Acute abdominal disease associated with gallbladder torsion recovered after cholecystectomy: a rare case report and literature review

Abstract

Background: Gallbladder torsion is very rare and easily misdiagnosed as biliary disease. It is defined as the rotation of the gallbladder along the axis of the cystic pedicle on the mesentery. As gallbladder rotation involves the gallbladder artery, the blood supply is blocked, resulting in gallbladder ischemia and eventual necrosis. If misdiagnosis occurs and treatment is delayed, gallbladder torsion can develop into a lethal disease. The typical imaging features of gallbladder torsion in this case are a good learning resource for our young physicians, as well as providing a rare, unusual and typical case for our current literature database.Case Description: We present a rare case of gallbladder torsion in a 19-year-old man. The patient complained of sudden recurrent pain and discomfort in the right upper abdomen with vomiting for 12 hours.Abdominal ultrasound and computed tomography (CT) scan showed gallbladder enlargement and signs of acute cholecystitis in emergency examination, and there were no signs of cholecystolithiasis. Considering that the patient was a young male and the patients prefer conservative treatment, symptomatic treatment was given. However, there was no obvious effect after 1 day of medical treatment, but severe abdominal pain in the upper right quadrant continues to progress. Finally, the patient underwent laparoscopic cholecystectomy, and the gallbladder was found to be enlarged with ischemic necrosis, which was caused by gallbladder torsion. The patient recovered 2 days after surgery and was discharged without complications.Conclusions: Although the clinical manifestation is similar to that of typical acute calculous cholecystitis, gallbladder torsion can be diagnosed early through some special signs on imaging examination, such as distorted cystic duct signs ("beak and whirl" sign), gallbladder dilatation with gallbladder fossa effusion, and gallbladder in the horizontal position. These signs can help primary surgical treatment and prevent fatal complications such as gallbladder gangrene, perforation, and biliary peritonitis. Therefore, for inexperienced doctors, careful imaging features are required for the correct diagnosis of rare gallbladder torsion.

Gallbladder volvulus in a 5–years old Vietnamese female: A case report

“…(4) Gallbladder wall thickening with diffusely hypoechoic, hypoperfused or anemic, indicating ischemia or necrosis. 4,[15][16][17] Abdominal CT scan with contrast shows "floating gallbladder" with the thickness of the gallbladder wall and poor enhancement or no enhancement indicative of ischemic and necrotic gallbladder. 16 Accurate interpretation of imaging results is very important in the diagnosis of GV.…”

“…Cholangiographic MRI can show a twisted cystic duct and the hyperdensity intra-wall of the gallbladder on T1W images suggestive of hemorrhagic necrosis. 3,15,18 The important steps during the cholecystectomy involve decompression and derotation of the gallbladder to obtain a clear view of the anatomical structures. Careful and meticulous dissection of the anatomical structure is essential because biliary structures such as the bile duct will be abnormally located because of the torsion, making it susceptible to iatrogenic injury.…”

“…This phenomenon is now defined as a gallbladder that twists on its elongated mesentery 14 . When the rotation is more than 180 degrees, it is considered to be complete, but, if the rotation is less than 180 degrees, then it is considered incomplete 1,15 …”

“…14 When the rotation is more than 180 degrees, it is considered to be complete, but, if the rotation is less than 180 degrees, then it is considered incomplete. 1,15 Both clockwise and counterclockwise rotation have been described; clockwise rotation has been proposed when it occurs as a result of gastric and duodenal peristalsis. 2,13 Whereas, counterclockwise rotation is secondary to colonic peristalsis.…”

GSTM1 and GSTT1 Gene Polymorphisms with Gallbladder Carcinoma

“…With the progress of science and technology, now in the etiology, molecular biology, diagnosis and treatment methods continue to deepen, constantly to improve the detection of special tumor markers, which is very helpful in the early diagnosis of gallbladder cancer. Adjuvant therapy provides a favorable technology for improving the survival rate of patients with gallbladder cancer, and molecular targeted drugs are a new treatment method (25,26). When the gene distribution frequency of cholecystitis is low, the development trend of cholecystitis will be easier in the experiment.…”