Torsion of the gallbladder: report of a case

Abstract

Torsion of the gallbladder is a rare entity that is difficult to diagnose preoperatively. The condition occurs most often in the elderly. Although its etiology is unknown, a constant finding is the presence of the gallbladder on a mobile mesentery (floating gallbladder). Torsion, or volvulus, of the gallbladder occurs when it twists axially, with the subsequent occlusion of bile and/or blood flow. Herein, a case of torsion of the gallbladder is presented where preoperative computed tomographic scan and laparoscopy were successfully used to diagnose and treat this condition without the usual requirement of open exploration. Given the possibility of laparoscopic cholecystectomy and the increasing incidence with which torsion of the gallbladder is being witnessed today, the importance of a preoperative computed tomographic scan is emphasized when there is a high index of clinical suspicion.

Fig. 1

A, B. Preoperative contrast-enhanced axial computed tomographic scan demonstrated a massively distended "floating gallbladder" outside its fossa and inferior to the liver, with a conical structure (arrow), connecting the gallbladder to the liver (G; gallbladder). No stones were identified.

Fig. 2

During the laparoscopic procedure, the gallbladder was markedly distended, hemorrhagic and "floating" away from the liver bed.