Acute Choleystitis due to Torsion of the Gallbladder

Her, Jun; Jang, Kwang Sik

Abstract

Torsion of the gallbladder is a uncommon disease. Since Wendel reported the first case of torsion of the gallbladder in 1898, approximately 400 or more cases have been reported on. A mobile gallbladder with abnormal anatomical fixation to the liver is required for this torsion. Twisting of the mobile gallbladder on its pedicle creates occlusion of the blood supply or bile flow to the organ, and gangrene and necrosis finally occurs. Prompt surgery is required for this condition. Unless cholecystectomy is performed, this condition could cause severe postoperative complications or death to the patient. Torsion of the gallbladder has been known to occur frequently in thin, elderly females. Because of its medical rarity, diagnosis of torsion prior to operative exploration is extremely difficult and the diagnosis is generally maded by laparotomy. We report here on a case of torsion of the gallbladder. The patient was an 82 years old female who complained of severe epigastric pain, nausea, and vomiting. Ultrasonography and computed tomography were performed and these modalities demonstrated a distended gallbladder with wall thickening; the gallbladder didn't contain stones. Explorative laparotomy and cholecystectomy was then performed. We found that the necrotized gallbladder was twisted around its pedicle. We report here on a case of gallbladder torsion and we discuss the clinical features and diagnostic methods for this malady.