Limits...
A rare case of gallbladder torsion along the axis of body: a case report.

Kwon HJ, Kim SG - Korean J Hepatobiliary Pancreat Surg (2015)

Bottom Line: During emergency laparotomy, the middle portion of the gallbladder was found to be twisted counterclockwise with huge gangrenous gallbladder distal.Cholecystectomy was performed and the patient was discharged 2 weeks later without postoperative complications.Histological findings of specimen were consistent with operative findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea.

ABSTRACT
Abnormal attachment of the gallbladder to the liver is the main cause for gallbladder torsion. However, the present study reports a rare case of gallbladder torsion in which a portion of fundus is rotated along the axis of body. So far, very few similar cases have been reported. An 87-year-old woman complaining right upper quadrant abdominal pain for 4 days was admitted. Her body temperature was 38.5℃ with moderate dehydration. A large tender mass was palpated on the right abdomen extending to the right iliac fossa. Computed tomography of abdomen showed a large cavity with a diameter of 15 cm containing a big stone and a small normal looking gallbladder. Ultrasonographic scan showed a twisted portion of the gallbladder torsion. During emergency laparotomy, the middle portion of the gallbladder was found to be twisted counterclockwise with huge gangrenous gallbladder distal. The proximal body of the gallbladder was spared and attached firmly to the liver. Cholecystectomy was performed and the patient was discharged 2 weeks later without postoperative complications. Histological findings of specimen were consistent with operative findings. The current study reports on a rare case of gallbladder torsion by reviewing previous studies.

No MeSH data available.


Related in: MedlinePlus

Imaging and operative findings. (A) The large cavity with largest diameter of 15 cm had wall thickening containing large stone. (B) Doppler ultrasonography confirmed blood flow in the gallbladder proximal to the twisted portion but no blood flow in the distal huge cavity. (C) The surgical specimen showed a normal cystic duct, gallbladder neck, and proximal body attached firmly on the gallbladder bed.tThe distal portion of gallbladder was twisted 360 degree in counterclockwise direction around the axis of the gallbladder. (D) The illustration shows torsion of the fundus along the axis of the body in the counterclockwise direction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4494083&req=5

Figure 1: Imaging and operative findings. (A) The large cavity with largest diameter of 15 cm had wall thickening containing large stone. (B) Doppler ultrasonography confirmed blood flow in the gallbladder proximal to the twisted portion but no blood flow in the distal huge cavity. (C) The surgical specimen showed a normal cystic duct, gallbladder neck, and proximal body attached firmly on the gallbladder bed.tThe distal portion of gallbladder was twisted 360 degree in counterclockwise direction around the axis of the gallbladder. (D) The illustration shows torsion of the fundus along the axis of the body in the counterclockwise direction.

Mentions: An 87-year-old woman complaining of abdominal pain in the right upper quadrant, nausea and vomiting for 4 days was admitted to the emergency room. She was moderately dehydrated with fever (38.5℃) but her vital signs were normal. On physical examination, a large, firm and tender mass was palpable on the right abdomen. Her conjunctiva was not icteric. Liver function test was normal. Computed tomography of abdomen showed a large and small cavity (Fig. 1A). The large cavity with the largest diameter of 15 cm had wall thickening and contained a large stone. The 3 cm-sized small cavity under the liver seemed to be a portion of normal gallbladder. The wall of large cavity was thickened and seemed to be the gangrenous portion distal to the twisted body of gallbladder. Ultrasonography demonstrated a portion of gallbladder rotating in a counterclockwise direction along the axis of gallbladder. Doppler ultrasonography confirmed blood flow in the small cavity proximal to the twisted portion, but there was no blood flow in the huge cavity distal to the twisted portion of the gallbladder (Fig. 1B). Gallbladder torsion was suggested preoperatively, based on the imaging findings. During laparotomy, a normal cystic duct, gallbladder neck, and proximal body was found to be attached firmly on the gallbladder bed. Moreover, the distal portion of gallbladder was twisted 360 degree in counterclockwise direction around the axis of gallbladder resulting in huge distension with severe gangrenous change of distal gallbladder (Fig. 1C). The mechanism of gallbladder torsion was illustrated (Fig. 1D). Cholecystectomy was performed and the patient was discharged 2 weeks later without postoperative complication. Histopathology showed mild inflammation found in the proximal part of the gallbladder in contrast to necrosis and gangrenous changes found in the distal gallbladder.


A rare case of gallbladder torsion along the axis of body: a case report.

Kwon HJ, Kim SG - Korean J Hepatobiliary Pancreat Surg (2015)

Imaging and operative findings. (A) The large cavity with largest diameter of 15 cm had wall thickening containing large stone. (B) Doppler ultrasonography confirmed blood flow in the gallbladder proximal to the twisted portion but no blood flow in the distal huge cavity. (C) The surgical specimen showed a normal cystic duct, gallbladder neck, and proximal body attached firmly on the gallbladder bed.tThe distal portion of gallbladder was twisted 360 degree in counterclockwise direction around the axis of the gallbladder. (D) The illustration shows torsion of the fundus along the axis of the body in the counterclockwise direction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494083&req=5

Figure 1: Imaging and operative findings. (A) The large cavity with largest diameter of 15 cm had wall thickening containing large stone. (B) Doppler ultrasonography confirmed blood flow in the gallbladder proximal to the twisted portion but no blood flow in the distal huge cavity. (C) The surgical specimen showed a normal cystic duct, gallbladder neck, and proximal body attached firmly on the gallbladder bed.tThe distal portion of gallbladder was twisted 360 degree in counterclockwise direction around the axis of the gallbladder. (D) The illustration shows torsion of the fundus along the axis of the body in the counterclockwise direction.
Mentions: An 87-year-old woman complaining of abdominal pain in the right upper quadrant, nausea and vomiting for 4 days was admitted to the emergency room. She was moderately dehydrated with fever (38.5℃) but her vital signs were normal. On physical examination, a large, firm and tender mass was palpable on the right abdomen. Her conjunctiva was not icteric. Liver function test was normal. Computed tomography of abdomen showed a large and small cavity (Fig. 1A). The large cavity with the largest diameter of 15 cm had wall thickening and contained a large stone. The 3 cm-sized small cavity under the liver seemed to be a portion of normal gallbladder. The wall of large cavity was thickened and seemed to be the gangrenous portion distal to the twisted body of gallbladder. Ultrasonography demonstrated a portion of gallbladder rotating in a counterclockwise direction along the axis of gallbladder. Doppler ultrasonography confirmed blood flow in the small cavity proximal to the twisted portion, but there was no blood flow in the huge cavity distal to the twisted portion of the gallbladder (Fig. 1B). Gallbladder torsion was suggested preoperatively, based on the imaging findings. During laparotomy, a normal cystic duct, gallbladder neck, and proximal body was found to be attached firmly on the gallbladder bed. Moreover, the distal portion of gallbladder was twisted 360 degree in counterclockwise direction around the axis of gallbladder resulting in huge distension with severe gangrenous change of distal gallbladder (Fig. 1C). The mechanism of gallbladder torsion was illustrated (Fig. 1D). Cholecystectomy was performed and the patient was discharged 2 weeks later without postoperative complication. Histopathology showed mild inflammation found in the proximal part of the gallbladder in contrast to necrosis and gangrenous changes found in the distal gallbladder.

Bottom Line: During emergency laparotomy, the middle portion of the gallbladder was found to be twisted counterclockwise with huge gangrenous gallbladder distal.Cholecystectomy was performed and the patient was discharged 2 weeks later without postoperative complications.Histological findings of specimen were consistent with operative findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea.

ABSTRACT
Abnormal attachment of the gallbladder to the liver is the main cause for gallbladder torsion. However, the present study reports a rare case of gallbladder torsion in which a portion of fundus is rotated along the axis of body. So far, very few similar cases have been reported. An 87-year-old woman complaining right upper quadrant abdominal pain for 4 days was admitted. Her body temperature was 38.5℃ with moderate dehydration. A large tender mass was palpated on the right abdomen extending to the right iliac fossa. Computed tomography of abdomen showed a large cavity with a diameter of 15 cm containing a big stone and a small normal looking gallbladder. Ultrasonographic scan showed a twisted portion of the gallbladder torsion. During emergency laparotomy, the middle portion of the gallbladder was found to be twisted counterclockwise with huge gangrenous gallbladder distal. The proximal body of the gallbladder was spared and attached firmly to the liver. Cholecystectomy was performed and the patient was discharged 2 weeks later without postoperative complications. Histological findings of specimen were consistent with operative findings. The current study reports on a rare case of gallbladder torsion by reviewing previous studies.

No MeSH data available.


Related in: MedlinePlus