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Gallbladder volvulus with gangrene. Case report and review of the literature.

Christoudias GC - JSLS (1997 Apr-Jun)

Bottom Line: Over 300 cases have appeared in the literature since first reported by Wendel in 1898, ranging in age from 2 to 100 years old.Unusual mobility of the gallbladder due to congenital anomalies is a constant factor in all occurrences.The patient had an uneventful recovery and was discharged within 72 hours after surgery, indicating that with the proper technique laparoscopic cholecystectomy is both feasible and safe in gallbladder volvulus.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Volvulus of the gallbladder is an unusual event. Over 300 cases have appeared in the literature since first reported by Wendel in 1898, ranging in age from 2 to 100 years old. Unusual mobility of the gallbladder due to congenital anomalies is a constant factor in all occurrences.

Case report: This is a report of a laparoscopic cholecystectomy in an 82-year-old white female with volvulus of the gallbladder presenting with a chief complaint of chest pain.

Conclusion: The patient had an uneventful recovery and was discharged within 72 hours after surgery, indicating that with the proper technique laparoscopic cholecystectomy is both feasible and safe in gallbladder volvulus.

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Related in: MedlinePlus

Careful dissection of the cystic duct-common bile duct junction clearly demonstrates the vicinity of the junction to the anterior edge of the liver.
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Figure 4: Careful dissection of the cystic duct-common bile duct junction clearly demonstrates the vicinity of the junction to the anterior edge of the liver.

Mentions: Laparoscopic exploration showed a gallbladder located away from its normal position and completely covered by the omentum with loose circumferential adhesions. The omentum was then gently “peeled off” the gallbladder with a blunt gauze dissector, uncovering a gangrenous edematous and distended gallbladder which was very difficult to manipulate. A 14-gauge angiocath was then inserted into the gallbladder percutaneously and connected to suction; sufficient amount of intracholecystic fluid was aspirated to allow grasping of the gallbladder wall. The gallbladder was then grasped at the fundus and retracted cephalad, exposing a twisted gallbladder pedicle (Figure 2). This pedicle was pink and healthy posteriorly and gangrenous anteriorly beyond the point of torsion. By coordinating the gallbladder grasper and the gauze dissector, the gallbladder was untwisted in a counterclockwise motion. With the gall-bladder pedicle reduced, it was evident that it allowed an unusually high freedom of movement of the gallbladder, which was only partially attached to the liver at the level of the gallbladder neck (Figure 3). The cystic duct was cannulated with a #4 French ureteral catheter and a cholangiogram was done. The cholangiogram was normal. The pedicle was unusually long with the common bile duct stretched close to the level of the anterior edge of the liver (Figure 4). The cystic duct and artery were carefully identified and divided between hemoclips. The removal of the gallbladder off the liver bed was easily accomplished by dividing with cautery the limited area of gallbladder attachment to the liver bed (Figure 5). The gallbladder was then placed in a retrieval bag and removed through the epigastric stab wound. Aerobic and anaerobic gallbladder cultures were taken and both proved negative.


Gallbladder volvulus with gangrene. Case report and review of the literature.

Christoudias GC - JSLS (1997 Apr-Jun)

Careful dissection of the cystic duct-common bile duct junction clearly demonstrates the vicinity of the junction to the anterior edge of the liver.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021271&req=5

Figure 4: Careful dissection of the cystic duct-common bile duct junction clearly demonstrates the vicinity of the junction to the anterior edge of the liver.
Mentions: Laparoscopic exploration showed a gallbladder located away from its normal position and completely covered by the omentum with loose circumferential adhesions. The omentum was then gently “peeled off” the gallbladder with a blunt gauze dissector, uncovering a gangrenous edematous and distended gallbladder which was very difficult to manipulate. A 14-gauge angiocath was then inserted into the gallbladder percutaneously and connected to suction; sufficient amount of intracholecystic fluid was aspirated to allow grasping of the gallbladder wall. The gallbladder was then grasped at the fundus and retracted cephalad, exposing a twisted gallbladder pedicle (Figure 2). This pedicle was pink and healthy posteriorly and gangrenous anteriorly beyond the point of torsion. By coordinating the gallbladder grasper and the gauze dissector, the gallbladder was untwisted in a counterclockwise motion. With the gall-bladder pedicle reduced, it was evident that it allowed an unusually high freedom of movement of the gallbladder, which was only partially attached to the liver at the level of the gallbladder neck (Figure 3). The cystic duct was cannulated with a #4 French ureteral catheter and a cholangiogram was done. The cholangiogram was normal. The pedicle was unusually long with the common bile duct stretched close to the level of the anterior edge of the liver (Figure 4). The cystic duct and artery were carefully identified and divided between hemoclips. The removal of the gallbladder off the liver bed was easily accomplished by dividing with cautery the limited area of gallbladder attachment to the liver bed (Figure 5). The gallbladder was then placed in a retrieval bag and removed through the epigastric stab wound. Aerobic and anaerobic gallbladder cultures were taken and both proved negative.

Bottom Line: Over 300 cases have appeared in the literature since first reported by Wendel in 1898, ranging in age from 2 to 100 years old.Unusual mobility of the gallbladder due to congenital anomalies is a constant factor in all occurrences.The patient had an uneventful recovery and was discharged within 72 hours after surgery, indicating that with the proper technique laparoscopic cholecystectomy is both feasible and safe in gallbladder volvulus.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Volvulus of the gallbladder is an unusual event. Over 300 cases have appeared in the literature since first reported by Wendel in 1898, ranging in age from 2 to 100 years old. Unusual mobility of the gallbladder due to congenital anomalies is a constant factor in all occurrences.

Case report: This is a report of a laparoscopic cholecystectomy in an 82-year-old white female with volvulus of the gallbladder presenting with a chief complaint of chest pain.

Conclusion: The patient had an uneventful recovery and was discharged within 72 hours after surgery, indicating that with the proper technique laparoscopic cholecystectomy is both feasible and safe in gallbladder volvulus.

Show MeSH
Related in: MedlinePlus