Complete body-neck torsion of the gallbladder: a case report

Abstract

Gallbladder torsion is a rare, acute abdominal disease. It was first reported by Wendell in 1898. Since then, only 500 cases have been reported. Gallbladder torsion occurs in all age groups, although it usually appears in the latter stages of life. The occurrence ratio between women and men is 3:1. Most cases are diagnosed during surgery. The main treatment is surgical detorsion and cholecystectomy. Despite progress in radiologic imaging diagnosis, it is not easy to obtain a precise preoperative diagnosis of gallbladder torsion. In previous reports, only 9.8% of all gallbladder torsion cases were diagnosed preoperatively. We present a case of acute body-neck gallbladder torsion in an elderly man, and we review the radiologic findings of magnetic resonance imaging, computed tomography, and ultrasonography. The radiologic findings in the present case were helpful in obtaining a preoperative diagnosis of gallbladder torsion. The diagnosis was confirmed by T2-weighted magnetic resonance images, which showed an intra-gallbladder segment located between the body and neck of the gallbladder, with a notable crease within this segment.

Keywords: Acute abdomen; Cholecystectomy; Detorsion; Gallbladder torsion; Gallbladder volvulus; Laparoscopy; Magnetic resonance imaging.

Figure 1

Abdominal ultrasonography. Ultrasonography revealed a large, thick-walled gallbladder and the absence of gallstones.

Figure 2

Abdominal computed tomography scan. A: Computed tomography scan of abdomen in axial section indicating a hyperdense lesion (arrow); B: The hepatic cyst was located in the hilar region (arrow).

Figure 3

Abdominal T1-weighted and coronal reformatted abdominal T2-weighted magnetic resonance imaging. A: Thickening of the gallbladder wall can be seen (arrow); B: An intra-gallbladder segment was located between the body and neck of the gallbladder (arrow), and within this segment, there was a notable crease.

Figure 4

Magnetic resonance cholangiopancreatography results and image. A: V-shaped distortion of the extrahepatic bile ducts (arrowhead) and tapered cystic duct (arrow) were observed; B: Choledochal cyst was excluded.

Figure 5

Laparoscopy. A: Gallbladder appeared gangrenous; B: Gallbladder was not totally attached to the liver bed and had twisted approximately 180° in the clockwise direction (arrow). Hartmann’s pouch and the gallbladder neck were attached to the inferior surface of the liver (arrowhead).

Figure 6

Gross type 1 floating gallbladder. Clockwise torsion was observed at the neck-body junction of the gallbladder (arrow), as the result of the gallbladder being attached to the inferior surface of the liver via the mesentery. This condition allowed the gallbladder to hang free in an unstable state.