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Baig Z, Ljubojevic V, Christian F. The diagnostic dilemma of a gallbladder volvulus: An unusual case report and review of the literature. Int J Surg Case Rep 2021; 80:105614. [PMID: 33601326 PMCID: PMC7898076 DOI: 10.1016/j.ijscr.2021.01.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 02/07/2023] Open
Abstract
Gallbladder volvulus is a challenging radiological diagnosis. Hepatobiliary iminodiacetic acid (HIDA) scans demonstrate no filling of the gallbladder in gallbladder volvulus. Persisting cholecystitis symptoms in the absence of gallstones can be indicative of gallbladder volvulus.
Introduction and importance A gallbladder volvulus is a rare medical condition requiring emergency surgery. There are 500 cases reported in the literature, and only 10 % have ever been diagnosed preoperatively. Gallbladder volvulus occurs when the gallbladder torts around the cystic duct and cystic artery resulting in occlusion of both structures and consequently, ischemia of the gallbladder. The diagnosis is challenging because the symptoms mimic cholecystitis without distinct radiological features specific for a volvulus. Case presentation In this article, we report the case of a 77-year-old female who underwent ultrasonography (US), computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and cholescintigraphy, which all reported features of cholecystitis. She underwent a cholecystectomy on admission day 5 because of refractory pain despite treatment with intravenous antibiotics. Intraoperatively, she was discovered to have complete gallbladder torsion with gangrene. Post-operatively, she had immediate and complete resolution of pain, and made a rapid recovery. Clinical discussion We review the available literature to determine radiological characteristics specific to a gallbladder volvulus. Patients without cholelithiasis and incomplete filling of the gallbladder in a nuclear medicine scan should be evaluated for gallbladder volvulus. Conclusion Through this report, we suggest a high index of suspicion for gallbladder volvulus in elderly female patients with signs and symptoms of acalculous cholecystitis that have no resolution in symptoms with conservative management.
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Affiliation(s)
- Zarrukh Baig
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada.
| | | | - Francis Christian
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada; Professor of Surgery, University of Saskatchewan, Saskatoon, Canada
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Ahluwalia A, Allaway MGR, Giga S, Curran RJ. Torsion of the gallbladder: a rare but important differential to consider when treating acute cholecystitis non-operatively. BMJ Case Rep 2021; 14:14/1/e237842. [PMID: 33408103 PMCID: PMC7789040 DOI: 10.1136/bcr-2020-237842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.
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Affiliation(s)
- Arun Ahluwalia
- Blacktown Hospital, Blacktown, New South Wales, Australia
| | | | - Serena Giga
- Blacktown Hospital, Blacktown, New South Wales, Australia
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Nguyen TH, Tran KH, Le XA, Nguyen HV, Ha QV. Gallbladder volvulus and hernia through the foramen of Winslow: a case report. J Surg Case Rep 2020; 2020:rjaa424. [PMID: 33154812 PMCID: PMC7602362 DOI: 10.1093/jscr/rjaa424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/29/2020] [Accepted: 09/17/2020] [Indexed: 11/15/2022] Open
Abstract
Gallbladder hernia through the foramen of Winslow is an uncommon condition and gallbladder hernia combined with volvulus is even rarer. A 70-year-old patient was hospitalized with the clinical signs of pain in the right hypochondriac region associated with fever. The computed tomography scan images showed some signs of gallbladder herniation through the foramen of Winslow. We decided to remove the gallbladder and found the gallbladder infundibulum twisted and necrotic. This was the first case of a male patient who suffered from gallbladder herniation with volvulus after three cases of female patients reported in the literature.
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Affiliation(s)
- Toan Huy Nguyen
- Department of General Surgery, Nghe An General Hospital, Nghe An Province, Vietnam
- Correspondence address. Department of General Surgery, Nghe An General Hospital, Lenin Boulevard, Nghi Phu Ward, Vinh City, Nghe An Province, Vietnam. Tel: +84-946 254777; E-mail:
| | - Kinh Huy Tran
- Department of General Surgery, Nghe An General Hospital, Nghe An Province, Vietnam
| | - Xuan Anh Le
- Department of General Surgery, Nghe An General Hospital, Nghe An Province, Vietnam
| | - Huong Van Nguyen
- Department of General Surgery, Nghe An General Hospital, Nghe An Province, Vietnam
| | - Quyet Van Ha
- Department of General Surgery, Ha Noi Medical University, Ha Noi City, Vietnam
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Affiliation(s)
- Katherine Copely
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY, 40536-0293, USA
| | - Adrian Dawkins
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY, 40536-0293, USA.
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Chai JS, Wang X, Li XZ, Yao P, Yan ZZ, Zhang HJ, Ning JY, Cao YB. Presentation of gallbladder torsion at an abnormal position: A case report. World J Clin Cases 2020; 8:2667-2673. [PMID: 32607348 PMCID: PMC7322416 DOI: 10.12998/wjcc.v8.i12.2667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/09/2020] [Accepted: 05/27/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gallbladder torsion is a rare acute abdominal condition that requires emergency surgery. It occurs more commonly in elderly people and in women in the adult population. Diagnosis is a challenge as non-specific symptoms and signs have been reported on ultrasonography, computed tomography and magnetic resonance imaging. Prompt cholecystectomy can decrease the mortality and morbidity of perforation due to gallbladder torsion.
CASE SUMMARY An 82-year-old woman with upper-right quadrant pain and associated nausea and vomiting was diagnosed with ectopic acute calculus cholecystitis. Magnetic resonance cholangiopancreatography (MRCP) showed a V-shaped distortion of the extrahepatic bile ducts and a particularly extended twisted cystic duct, which indicated the presence of gallbladder torsion. Emergency laparoscopic cholecystectomy confirmed the diagnosis and the patient recovered without incident.
CONCLUSION Gallbladder torsion can be diagnosed pre-operatively by MRCP. The specific signs are a V-shaped distortion of the extrahepatic bile ducts and a particularly extended twisted cystic duct which can be called twisting signs.
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Affiliation(s)
- Jia-Sui Chai
- Department of Hepatobiliary Surgery, Yuncheng Central Hospital, the Eighth Clinical College of Shanxi Medical University, Yuncheng 044031, Shanxi Province, China
| | - Xu Wang
- Department of Hepatobiliary Surgery, Yuncheng Central Hospital, the Eighth Clinical College of Shanxi Medical University, Yuncheng 044031, Shanxi Province, China
| | - Xiao-Zheng Li
- Department of Hepatobiliary Surgery, Yuncheng Central Hospital, the Eighth Clinical College of Shanxi Medical University, Yuncheng 044031, Shanxi Province, China
| | - Peng Yao
- Department of Hepatobiliary Surgery, Yuncheng Central Hospital, the Eighth Clinical College of Shanxi Medical University, Yuncheng 044031, Shanxi Province, China
| | - Zheng-Zheng Yan
- Department of General Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan 030032, Shanxi Province, China
| | - Hong-Jie Zhang
- Department of Hepatobiliary Surgery, Yuncheng Central Hospital, the Eighth Clinical College of Shanxi Medical University, Yuncheng 044031, Shanxi Province, China
| | - Jia-Yong Ning
- Department of Hepatobiliary Surgery, Yuncheng Central Hospital, the Eighth Clinical College of Shanxi Medical University, Yuncheng 044031, Shanxi Province, China
| | - Yan-Bing Cao
- Department of Hepatobiliary Surgery, Yuncheng Central Hospital, the Eighth Clinical College of Shanxi Medical University, Yuncheng 044031, Shanxi Province, China
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6
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A Case of Torsion of the Gallbladder Suspected with SPECT-CT: Review and Recommendations. Case Rep Surg 2020; 2020:8687141. [PMID: 31970008 PMCID: PMC6970005 DOI: 10.1155/2020/8687141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 12/07/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022] Open
Abstract
Torsion or volvulus of the gallbladder is a rare situation that rapidly progresses to gangrene and linked with a poor prognosis, even death, if unrecognized and untreated. An interesting and rare case of gallbladder volvulus in which diagnosis was obtained by comparing CT images and HIDA scan with SPECT-CT is presented. Relevant literature is reviewed, and recommendations are outlined.
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David R, Traeger L, McDonald C. Gall bladder torsion: a disease of the elderly. BMJ Case Rep 2019; 12:12/10/e227324. [PMID: 31645390 DOI: 10.1136/bcr-2018-227324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a gall bladder torsion in an elderly female patient, which was discovered during laparoscopic exploration for presumed acute cholecystitis. The rising incidence of this relatively uncommon process can be attributed to increasing life expectancy. Gall bladder torsion typically manifests in septuagenarians and octogenarians of the female gender, as seen in the presented case. It is thought that local mesenteric redundancy predisposes to the development of mechanical organoaxial torsion along the gall bladder's longitudinal axis involving the cystic duct and artery. Clinicians must have a high index of suspicion for gall bladder torsion, as a mimicker of acute cholecystitis, in the described patient demographic. Preoperative diagnosis is challenging with the vast majority of reported cases being diagnosed intraoperatively, and only five cases preoperatively. Prompt surgical intervention results in an overall mortality rate of approximately 5%, while a delay in diagnosis can lead to catastrophic patient outcomes.
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Affiliation(s)
- Rowan David
- Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Luke Traeger
- Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
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Skytte D, Schmökel H. Suspected Gallbladder Torsion in a Juvenile German Shepherd Dog. J Am Anim Hosp Assoc 2019; 55:e55603. [PMID: 31525094 DOI: 10.5326/jaaha-ms-6754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 11 mo old intact female German shepherd dog was presented with a 1 day history of vomiting, abdominal pain, and lethargy. A complete gallbladder torsion with secondary bile leakage was diagnosed during exploratory laparotomy. The dog underwent cholecystectomy at the clearly demarcated border of the viable cystic duct and recovered with no complications. Torsion was possible as a result of the complete absence of normal connective tissue attachments to the hepatic fossa, in human medicine called a wandering gallbladder. No other abnormalities were found on complete abdominal exploration. Very few cases describe torsion of the cystic duct as a cause for extrahepatic biliary disease and secondary bile peritonitis in dogs.
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Affiliation(s)
- Ditte Skytte
- From Evidensia Specialist Animal Hospital, Strömsholm, Sweden
| | - Hugo Schmökel
- From Evidensia Specialist Animal Hospital, Strömsholm, Sweden
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Bouhani M, Attaoui M. Incomplete gallbladder volvulus: A case report of a rare entity. HAMDAN MEDICAL JOURNAL 2019. [DOI: 10.4103/hmj.hmj_28_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Aljoe J. Gallbladder volvulus-acute cholecystitis 'with a twist'. J Surg Case Rep 2018; 2018:rjy303. [PMID: 30473760 PMCID: PMC6240736 DOI: 10.1093/jscr/rjy303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/24/2018] [Indexed: 01/05/2023] Open
Abstract
A Caucasian 92-year-old female was admitted to hospital with acute epigastric pain associated with vomiting. Initial investigations revealed mildly raised inflammatory markers, normal liver function tests but a markedly distended gallbladder with prominent wall thickening. The patient was managed with intravenous antibiotics for acute cholecystitis but deteriorated significantly on Day 2 of admission. An emergency laparoscopic cholecystectomy was performed and we found a gangrenous gallbladder secondary to gallbladder volvulus. The patient recovered well in the postoperative period and was discharged home 7 days later.
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Affiliation(s)
- James Aljoe
- General Surgery, Manly Hospital, 150 Darley Road Manly Sydney, Manly, New South Wales, Australia
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11
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Cui J, Abdullah M, Awan I, Mehanna D. Cholecystitis secondary to gallbladder torsion - A rare case report. Int J Surg Case Rep 2018; 46:13-15. [PMID: 29649696 PMCID: PMC6000732 DOI: 10.1016/j.ijscr.2018.03.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/17/2018] [Accepted: 03/27/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Gallbladder torsion is a rare condition of increasing prevalence in recent years. It is often difficult to diagnose pre-operatively and delayed intervention can lead to significant complications. PRESENTATION OF CASE We present a case of an 81 year old lady who presented with symptoms of cholecystitis for 24 h with no evidence of cholelithiasis on imaging. She deteriorated within 24 h of admission despite intravenous antibiotics; Emergency laparoscopy was performed which showed the gallbladder malrotated 180 ° with features of necrosis. Laparoscopic cholecystectomy was performed without complications. DISCUSSION The cause of gallbladder torsion are thought to be due to underlying anatomical variations or loss of elasticity associated with aging. Diagnosis is difficult clinically and radiologically, however, features such as "whirl sign" and "cystic duct knot sign" have been described. Due to ischemia associated with torsion, clinical vigilance and early intervention is recommended to prevent potential fatal sequelae particularly in the elderly population. CONCLUSION Gallbladder torsion is a rare finding that can be difficult to diagnose clinically, we are hoping to promote awareness to prevent complications associated with delayed therapy.
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Affiliation(s)
- Jason Cui
- General Surgical Department, Caboolture Hospital, QLD, 4510, Australia.
| | - Mariya Abdullah
- General Surgical Department, Caboolture Hospital, QLD, 4510, Australia
| | - Iman Awan
- General Surgical Department, Caboolture Hospital, QLD, 4510, Australia
| | - Daniel Mehanna
- General Surgical Department, Caboolture Hospital, QLD, 4510, Australia
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Kohga A, Okumura T, Suzuki K, Yajima K, Yamashita K, Isogaki J, Kawabe A, Kimura T. Strangulated gallbladder caused by a tip of the omentum attached to the abdominal wall: a case report. J Surg Case Rep 2017; 2017:rjx126. [PMID: 28721189 PMCID: PMC5507250 DOI: 10.1093/jscr/rjx126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/14/2017] [Indexed: 12/03/2022] Open
Abstract
Strangulation of the gallbladder associated with the omentum is extremely rare and, to our knowledge, only two cases have been previously reported. The patient was a 91-year-old female who presented to our emergency room with a chief complaint of upper abdominal pain. Computed tomography imaging revealed a gourd-shaped gallbladder with biphasic appearance divided clearly at the body. In the fundus side, the wall of the gallbladder was oedematous and thickened, while the neck side was intact. On the second day after onset, a laparoscopic cholecystectomy was performed. A tip of the omentum encircling the gallbladder was adhered to the abdominal wall and was strangling the gallbladder. By cutting the omentum at the attachment site, the strangulation was released. Laparoscopic cholecystectomy was performed, and the patient was discharged with an uneventful course. We experienced an extremely rare case of strangulated gallbladder caused by a tip of the omentum attached to the abdominal wall.
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Affiliation(s)
- Atsushi Kohga
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka 4180076,Japan
| | - Takuya Okumura
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka 4180076,Japan
| | - Kenji Suzuki
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka 4180076,Japan
| | - Kiyoshige Yajima
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka 4180076,Japan
| | - Kimihiro Yamashita
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka 4180076,Japan
| | - Jun Isogaki
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka 4180076,Japan
| | - Akihiro Kawabe
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka 4180076,Japan
| | - Taizo Kimura
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka 4180076,Japan
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Bekki T, Abe T, Amano H, Fujikuni N, Okuda H, Sasada T, Yamaki M, Kobayashi T, Noriyuki T, Nakahara M. Complete torsion of gallbladder following laparoscopic cholecystectomy: A case study. Int J Surg Case Rep 2017; 37:257-260. [PMID: 28732300 PMCID: PMC5517785 DOI: 10.1016/j.ijscr.2017.06.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/23/2017] [Accepted: 06/25/2017] [Indexed: 01/29/2023] Open
Abstract
Accurate preoperative diagnosis of gallbladder torsion is challenging because of the absence of clinical characteristics associated with it. Careful attention to symptoms during clinical presentation, including acute severe pain in the right quadrant and gallbladder deviation observed during radiological investigation, is required for accurate diagnosis of the condition. Upon confirmation of diagnosis, laparoscopic cholecystectomy would be the gold-standard treatment option rather than open cholecystectomy.
Introduction Gallbladder torsion is mainly associated with a floating gallbladder. From an anatomical perspective, laparoscopic cholecystectomy is a more optimal treatment than open cholecystectomy. Presentation of case An 84-year-old woman visited the Onomichi General Hospital because of progressive pain in the right upper quadrant of her abdomen. Physical examination revealed a positive Murphy sign and peritoneal irritation. Laboratory data demonstrated that inflammatory marker levels were increased. Abdominal ultrasonography showed that blood flow in the cystic artery was reduced and the gallbladder was swollen. Abdominal contrast-enhanced computerized tomography indicated that the swollen gallbladder was modestly enhanced and the fundus was displaced under the midline and detached from the gallbladder bed. The cystic duct was twisted. Magnetic resonance cholangiopancreatography showed that the root of the cystic duct was unclear and the extrahepatic bile duct had V-shaped distortion. The gallbladder neck showed a tapering interruption with the common biliary duct. We made a preoperative diagnosis of gallbladder torsion. Accordingly, emergency laparoscopic cholecystectomy was performed. The intraoperative findings included a dark swollen gallbladder that was twisted in the counterclockwise direction. The patient was discharged without any postoperative complications on day 7. Discussion Combined acute onset of abdominal pain with characteristic radiological findings made it possible to precisely diagnose gallbladder torsion. Conclusion Laparoscopic cholecystectomy can be the gold standard treatment for gallbladder torsion after a preoperative diagnosis is made.
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Affiliation(s)
- Tomoaki Bekki
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Tomoyuki Abe
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
| | - Hironobu Amano
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuaki Fujikuni
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Hiroshi Okuda
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Tatsunari Sasada
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Minoru Yamaki
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshio Noriyuki
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Nakahara
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
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Donati M, Brancato G, Scilletta R, Deiana E, Basile G. A Surgical “Chimera”: The Gallbladder Volvulus in the Spigelian Hernia Sac. Am Surg 2017. [DOI: 10.1177/000313481708300108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marcello Donati
- Department of Surgery and Medical-Surgical Specialties General and Oncologic Surgery Unit Vittorio-Emanuele University Hospital of Catania University of Catania, Italy
| | - Giovanna Brancato
- Department of Surgery and Medical-Surgical Specialties Emergency Abdominal Surgery Unit University Hospital of Catania University of Catania, Italy
| | - Roberto Scilletta
- Department of Surgical Sciences Organ Transplantation and Advanced Technologies University of Catania Catania, Italy
| | - Enrica Deiana
- Department of Surgery and Medical-Surgical Specialties General and Oncologic Surgery Unit Vittorio-Emanuele University Hospital of Catania University of Catania, Italy
| | - Guido Basile
- Department of Surgery and Medical-Surgical Specialties General and Oncologic Surgery Unit Vittorio-Emanuele University Hospital of Catania University of Catania, Italy
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Abadía-Barnó P, Coll-Sastre M, Picón-Serrano C, Sanjuanbenito-Dehesa A, Cabañas-Montero J. [Gallbladder volvulus: Diagnostic and surgical challenges]. CIR CIR 2016; 85 Suppl 1:89-92. [PMID: 27955849 DOI: 10.1016/j.circir.2016.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 10/18/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The gallbladder volvulus is defined as the rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. It is an extremely rare surgical disease and definitive diagnosis is usually made during surgery. CASE REPORT A 78 year old woman presented with upper right quadrant abdominal pain, with no comorbidities and no other accompanying symptoms. Analysis revealed haemodynamic instability and leukocytosis. Computed tomography of abdomen showed an acute cholecystitis. During emergency right hypochondrium laparotomy, the gallbladder was found to be twisted counterclockwise with huge gangrenous gallbladder distal. Open cholecystectomy was performed and after the surgery, the patient was discharged in a few days. CONCLUSION Gallbladder volvulus, or gallbladder torsion, is a rare condition and should be considered when clinical and imaging findings of complicated cholecystitis are present. The performance of urgent laparoscopic surgery would be first option to avoid perforation, peritonitis and haemodynamic instability.
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Affiliation(s)
- Pedro Abadía-Barnó
- Departamento de Cirugía General, Hospital Ramón y Cajal, Madrid, España.
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16
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Torsion of the gallbladder, localized in right subphrenic space in a patient with liver cirrhosis. Clin J Gastroenterol 2015; 8:435-7. [PMID: 26614480 DOI: 10.1007/s12328-015-0618-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/08/2015] [Indexed: 10/22/2022]
Abstract
We report a case of torsion of the gallbladder displaced under the right subphrenic space in a patient with liver cirrhosis. An 82-year-old Japanese woman was admitted to our hospital for acute pain in the right upper quadrant. Clinical features suggested gallbladder torsion. She was under treatment for hepatitis C virus-related cirrhosis at our hospital. Abdominal CT showed the swollen fundus and body of the gallbladder under the right subphrenic space. Emergency laparoscopic cholecystectomy was performed. Intraoperative findings included a grossly necrotic gallbladder in the right subphrenic space with 360° clockwise torsion, together with liver cirrhosis and localized peritonitis. The clinical features and imaging findings in this rare case of misplaced gallbladder in right subphrenic space resembled those described in typical strangulated gallbladder. The displacement was probably related to right liver lobe atrophy associated with liver cirrhosis. Appropriate diagnosis and prompt surgical treatment are essential for a positive outcome.
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17
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Gallbladder Volvulus Presenting as Acute Appendicitis. Case Rep Surg 2015; 2015:629129. [PMID: 26171270 PMCID: PMC4485550 DOI: 10.1155/2015/629129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/10/2015] [Indexed: 11/17/2022] Open
Abstract
We encountered a case of gallbladder volvulus in an 88-year-old thin female in which the initial presentation was more consistent with that of acute appendicitis. After complete work-up, including physical exam, lab work, and computed tomography, the definite diagnosis of gallbladder volvulus was not made until intraoperative visualization was obtained. Gallbladder volvulus is a rare but serious condition, which requires a high clinical suspicion so prompt surgical intervention can be undertaken.
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