Gallbladder Torsion: A Diagnostic Challenge

Abstract

80-year-old female presented with clinical findings suggestive of acute cholecystitis. Intraoperatively we discovered a dusky gallbladder with gangrenous patches and gallbladder torsion with 270 degrees clockwise rotation along the longitudinal axis. Gallbladder torsion is a rare cause of acute cholecystitis with less than 500 cases published in the literature. Gallbladder torsion should be included in the list of differential diagnoses in patients suspected of having acute cholecystitis especially when there are inconsistencies between clinical features and imaging. It is worth noting that 3-dimensional reconstructed CT may be useful in preoperative diagnosis of gallbladder torsion.

Acute Torsion of the Gallbladder

“…Since its first description in 1898 by Wendel [2], there have been over 500 documented cases in the literature. minimal or no attachment to the liver facilitates the longitudinal axis of the gallbladder to twist on its vascular root resulting in ischemia, necrosis and perforation [3,4]. Boonstra [5] suggested that torsion happens only in the absence of hepatic attachments and fixation to the liver.…”

Gallbladder Torsion: A Rare Diagnostic Challenge

“…Clinically mimicking acute cholecystitis, gallbladder torsion can be pre-operatively diagnosed incidentally with the use of conventional imaging modalities, namely abdominal ultrasound scan (USS), computed tomography (CT) and magnetic resonance cholangio-pancreatography (MRCP). Frequently the diagnosis is made intra-operatively during cholecystectomy [2][3][4]. We herein present a case of gallbladder torsion, which was detected intra-operatively during diagnostic laparoscopy for acute diffuse right-sided abdominal pain in the absence of definite radiological findings, despite the performance of extensive pre-operative abdominal imaging.…”