Gallbladder Torsion- A case report and review of literature
EAES Academy. Kumaran N. 07/05/22; 363037; P081
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Abstract
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Background:
Torsion of the gallbladder is a rare surgical entity. The clinical presentation mimics acute cholecystitis in most cases. There are no clear clinical signs for diagnosis and it has been reported that preoperative diagnosis is difficult.
Method
A 79 year old female patient presented with a six day history of right sided abdominal pain associated with nausea and reduced appetite. The patient was hypotensive, tachycardic and pyrexic. The white cell counts were 28.5, C-reactive protein was 270 and the eGFR was 14.5. The patient was resuscitated with intravenous antibiotics and fluids.
Results:
The patient had a CT abdomen which reported a large right flank fluid collection of unknown aetiology and possibilities include abscess related to biliary disease, peptic disease and colonic disease. The patient was taken for a laparotomy where the diagnosis of a torsion gallbladder was made intraoperatively. A cholecystectomy was performed. The postoperative period was uneventful.
Conclusion:
First reported by Wendel in 1898, gallbladder torsion is an uncommon surgical emergency. Predisposing factors are considered to be female sex and old age. The anatomical variation which predisposes the gallbladder for torsion is a long mesentery instead of a wider attachment to the liver. In some cases the mesentery might be absent altogether. Marano et al, in their report described the various anatomical variations seen in cases of gallbladder torsion. The first one is what they called a “free-floating gallbladder” suspended only by the mesentery of the cystic duct. The second type, is where the gallbladder has a long freely mobile mesentery where torsion occurs around the gallbladder or mesenteric axis. A recent metanalysis suggests that within the last twenty years a quarter of patients get diagnosed preoperatively.
The treatment of a gallbladder torsion is cholecystectomy. As expected, it is more than often, an open cholecystectomy, due to a diagnostic dilemma at presentation. However if a preoperative diagnosis is made a laparoscopic approach can be adopted as well. To conclude gallbladder torsion continues to be a rare diagnosis and can have varying presentations. Early intervention with a cholecystectomy continues to be the definitive treatment.
Torsion of the gallbladder is a rare surgical entity. The clinical presentation mimics acute cholecystitis in most cases. There are no clear clinical signs for diagnosis and it has been reported that preoperative diagnosis is difficult.
Method
A 79 year old female patient presented with a six day history of right sided abdominal pain associated with nausea and reduced appetite. The patient was hypotensive, tachycardic and pyrexic. The white cell counts were 28.5, C-reactive protein was 270 and the eGFR was 14.5. The patient was resuscitated with intravenous antibiotics and fluids.
Results:
The patient had a CT abdomen which reported a large right flank fluid collection of unknown aetiology and possibilities include abscess related to biliary disease, peptic disease and colonic disease. The patient was taken for a laparotomy where the diagnosis of a torsion gallbladder was made intraoperatively. A cholecystectomy was performed. The postoperative period was uneventful.
Conclusion:
First reported by Wendel in 1898, gallbladder torsion is an uncommon surgical emergency. Predisposing factors are considered to be female sex and old age. The anatomical variation which predisposes the gallbladder for torsion is a long mesentery instead of a wider attachment to the liver. In some cases the mesentery might be absent altogether. Marano et al, in their report described the various anatomical variations seen in cases of gallbladder torsion. The first one is what they called a “free-floating gallbladder” suspended only by the mesentery of the cystic duct. The second type, is where the gallbladder has a long freely mobile mesentery where torsion occurs around the gallbladder or mesenteric axis. A recent metanalysis suggests that within the last twenty years a quarter of patients get diagnosed preoperatively.
The treatment of a gallbladder torsion is cholecystectomy. As expected, it is more than often, an open cholecystectomy, due to a diagnostic dilemma at presentation. However if a preoperative diagnosis is made a laparoscopic approach can be adopted as well. To conclude gallbladder torsion continues to be a rare diagnosis and can have varying presentations. Early intervention with a cholecystectomy continues to be the definitive treatment.
Background:
Torsion of the gallbladder is a rare surgical entity. The clinical presentation mimics acute cholecystitis in most cases. There are no clear clinical signs for diagnosis and it has been reported that preoperative diagnosis is difficult.
Method
A 79 year old female patient presented with a six day history of right sided abdominal pain associated with nausea and reduced appetite. The patient was hypotensive, tachycardic and pyrexic. The white cell counts were 28.5, C-reactive protein was 270 and the eGFR was 14.5. The patient was resuscitated with intravenous antibiotics and fluids.
Results:
The patient had a CT abdomen which reported a large right flank fluid collection of unknown aetiology and possibilities include abscess related to biliary disease, peptic disease and colonic disease. The patient was taken for a laparotomy where the diagnosis of a torsion gallbladder was made intraoperatively. A cholecystectomy was performed. The postoperative period was uneventful.
Conclusion:
First reported by Wendel in 1898, gallbladder torsion is an uncommon surgical emergency. Predisposing factors are considered to be female sex and old age. The anatomical variation which predisposes the gallbladder for torsion is a long mesentery instead of a wider attachment to the liver. In some cases the mesentery might be absent altogether. Marano et al, in their report described the various anatomical variations seen in cases of gallbladder torsion. The first one is what they called a “free-floating gallbladder” suspended only by the mesentery of the cystic duct. The second type, is where the gallbladder has a long freely mobile mesentery where torsion occurs around the gallbladder or mesenteric axis. A recent metanalysis suggests that within the last twenty years a quarter of patients get diagnosed preoperatively.
The treatment of a gallbladder torsion is cholecystectomy. As expected, it is more than often, an open cholecystectomy, due to a diagnostic dilemma at presentation. However if a preoperative diagnosis is made a laparoscopic approach can be adopted as well. To conclude gallbladder torsion continues to be a rare diagnosis and can have varying presentations. Early intervention with a cholecystectomy continues to be the definitive treatment.
Torsion of the gallbladder is a rare surgical entity. The clinical presentation mimics acute cholecystitis in most cases. There are no clear clinical signs for diagnosis and it has been reported that preoperative diagnosis is difficult.
Method
A 79 year old female patient presented with a six day history of right sided abdominal pain associated with nausea and reduced appetite. The patient was hypotensive, tachycardic and pyrexic. The white cell counts were 28.5, C-reactive protein was 270 and the eGFR was 14.5. The patient was resuscitated with intravenous antibiotics and fluids.
Results:
The patient had a CT abdomen which reported a large right flank fluid collection of unknown aetiology and possibilities include abscess related to biliary disease, peptic disease and colonic disease. The patient was taken for a laparotomy where the diagnosis of a torsion gallbladder was made intraoperatively. A cholecystectomy was performed. The postoperative period was uneventful.
Conclusion:
First reported by Wendel in 1898, gallbladder torsion is an uncommon surgical emergency. Predisposing factors are considered to be female sex and old age. The anatomical variation which predisposes the gallbladder for torsion is a long mesentery instead of a wider attachment to the liver. In some cases the mesentery might be absent altogether. Marano et al, in their report described the various anatomical variations seen in cases of gallbladder torsion. The first one is what they called a “free-floating gallbladder” suspended only by the mesentery of the cystic duct. The second type, is where the gallbladder has a long freely mobile mesentery where torsion occurs around the gallbladder or mesenteric axis. A recent metanalysis suggests that within the last twenty years a quarter of patients get diagnosed preoperatively.
The treatment of a gallbladder torsion is cholecystectomy. As expected, it is more than often, an open cholecystectomy, due to a diagnostic dilemma at presentation. However if a preoperative diagnosis is made a laparoscopic approach can be adopted as well. To conclude gallbladder torsion continues to be a rare diagnosis and can have varying presentations. Early intervention with a cholecystectomy continues to be the definitive treatment.
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