Acute gallbladder torsion: an unexpected intraoperative finding

Abstract

Gallbladder torsion is an uncommon clinical entity and a difficult condition to diagnose preoperatively. Since its first description in 1898 by Wendel there have been over 500 documented cases in the literature. It is known to occur when there is rotation of the gallbladder along the axis of the cystic duct and vascular pedicle. Except for isolated cases reported in childhood, this disease is more frequently encountered in the elderly with 85% of the cases reported between the ages of 60 and 80 years. There is a female preponderance with a female to male ratio of 3:1. Gallbladder torsion typically presents as an acute abdomen requiring emergency surgery but preoperative diagnosis of gallbladder torsion is difficult and most cases are found as a surprise at surgery.We report a case of acute gallbladder torsion in an elderly lady and review the clinical aspect of the disease.

Figure 1

CT scan of the abdomen in horizontal section showing a cystic mass.

Figure 2

CT scan of the abdomen and pelvis in sagittal section.

Figure 3

Intraoperative finding of gangrenous gallbladder.

Figure 4

Opened gangrenous gallbladder.