Acute torsion of the gallbladder: a case report

Abstract

IntroductionTorsion of gallbladder is an uncommon cause of acute abdomen. Volvulus occurs along the long axis of the gallbladder mesentery, and according to the degree of rotation symptoms, and signs may vary.Case presentationA 79-year-old woman presented with a one-day history of acute onset of right upper abdominal pain. The patient underwent laparotomy with a preoperative diagnosis of acalculous cholecystitis with possible gangrene. At laparotomy, the gallbladder was distended, and multiple necrotic areas were observed. It was rotated more than 180 degrees clockwise around the mesentery, and cholecystectomy was performed.ConclusionCholecystectomy is the treatment of gallbladder torsion. Clinical signs and radiographic studies may be helpful to diagnose gallbladder torsion. Early diagnosis and surgical treatment lower the mortality of disease.

A Clinician’s Guide to the Diagnosis and Management of Gallbladder Volvulus

“…Since that early report, more than 500 cases have been reported in the world literature. [3][4][5][6][7][8][9][10] The clinical incidence of GV has been reported as 1 in 365,520 hospital admissions. 11 Multiple authors have postulated reasons for torsion of the gallbladder.…”

“…11,[13][14][15][16][17] Atherosclerosis of the cystic artery and a tortuous cystic duct are also hypothesized as cofactors, as they may serve as fulcrums for gallbladder torsion. 3,17 Other investigators have noted coexisting conditions that may predispose to GV. Nakao reviewed 245 cases in the Japanese literature, noting that GV tends to occur mainly in elderly women, although pediatric cases have been documented as well.…”

“…14,19 The extent of torsion, measured in degrees, can be used to differentiate between complete (>180 o ) and partial (<180 o ) torsion. 1,3,19 Incomplete volvulus may be misdiagnosed as biliary colic, whereas complete torsion produces unremitting, acute RUQ pain mimicking AC, and this ultimately results in infarction followed by perforation if not recognized promptly. 1,3,19 Clockwise torsion has been attributed to gastric peristalsis, whereas counterclockwise torsion has been linked to colonic peristalsis.…”

“…1,3,19 Incomplete volvulus may be misdiagnosed as biliary colic, whereas complete torsion produces unremitting, acute RUQ pain mimicking AC, and this ultimately results in infarction followed by perforation if not recognized promptly. 1,3,19 Clockwise torsion has been attributed to gastric peristalsis, whereas counterclockwise torsion has been linked to colonic peristalsis. 1, 16 Christoudias hypothesized that GV arising from visceral peristalsis alone is unlikely, given that 5% of the population has a "floating gallbladder" and the peristaltic movements of the gastrointestinal tract are continuous.…”

“…Ultrasound can reveal a clinical picture similar to that of AC, with a thickened wall and pericholecystic fluid ( Figure 2). 1,3 Although cholelithiasis visualized on ultrasound may also support a diagnosis of acute calculous cholecystitis, the assessing clinician must keep GV in the differential diagnosis, since ultrasound has a false-positive rate for gallstones of 3.9%. 23 Multiple authors report that ultrasound can also be extremely specific in diagnosing torsion when the gallbladder is located outside of the fossa and inferior to the liver, presenting an echogenic conical structure.…”