Preoperative diagnosis of gallbladder torsion by magnetic resonance cholangiopancreatography: A case report

Abstract

Gallbladder torsion is a rare and potentially fatal condition presenting with acute abdominal pain. Gallbladder torsion requires early diagnosis and treatment; however, preoperative diagnosis is difficult. In the present case, magnetic resonance cholangiopancreatography provided definitive imaging findings and was very useful in making the preoperative diagnosis.

Keywords: cholecystectomy; cholecystitis; gallbladder torsion; magnetic resonance cholangiopancreatography.

FIGURE 1

Contrast‐enhanced abdominal computed tomography. An enlarged gallbladder separated from the hepatic bed (A, red arrow) with gallstones is seen (A, yellow arrow), and the wall of the gallbladder is thickened; however, the contrast effect is maintained (B, red arrow)

FIGURE 2

Magnetic resonance cholangiopancreatography. The extrahepatic bile ducts are distorted on the right side and appear in the shape of the letter v (A, B: red arrow). The cystic duct (A, B: yellow arrow) is tapered and twisted around the pedicle with the swirl sign

FIGURE 3

Laparoscopy. The gallbladder is dark red, necrotic, distended, and almost floating, and is rotated 180° clockwise at its neck (A, yellow arrow). Untwisting the gallbladder (B) revealed that it was not completely attached to the bed of the liver (B, yellow arrows)

FIGURE 4

Resected specimen and histopathological findings. Resected specimen showing congestion with a dark red color and necrosis in all layers (A). The gallbladder wall is necrotic with marked epithelial shedding and marked congestion and bleeding (B, magnification ×40, hematoxylin and eosin stain)