Expect the Unexpected: Torsion of the Gallbladder, a Rare Cause for Acute Cholecystitis.

Yang Hwang,Jack Ashworth,Krish Kulendran

doi:10.7759/cureus.3726

Abstract

Gallbladder torsion is a rare cause for acute cholecystitis. Gallbladder torsion is unlikely to respond to conservative management and requires urgent surgical intervention. We report a case of an 85-year-old female with gallbladder torsion. She presented with a clinical picture consistent with acute cholecystitis. Radiological findings showed signs that elude to the diagnosis and intra-operative findings showed a complete torsion with a free-floating gallbladder. This case highlights the need to have a high index of suspicion for gallbladder torsion as a differential diagnosis for right upper quadrant (RUQ) pain apart from the typical calculous acute cholecystitis, especially in high risk groups such as thin, elderly females. Prompt decision for cholecystectomy is necessary and is likely to result in a good outcome.

Highlights

The “floating gallbladder” was first described by Wendel in 1898 [1], since over 500 cases have been reported, with 105 of these identified laparoscopically [2]
Gallbladder torsion is predominantly a condition of the elderly affecting those between the ages of 60 and 80, children can be affected [3]
The following case report is a typical presentation of gallbladder torsion, with supportive imaging and intraoperative images

Summary

Introduction

The “floating gallbladder” was first described by Wendel in 1898 [1], since over 500 cases have been reported, with 105 of these identified laparoscopically [2]. The most commonly accepted mechanisms for gallbladder torsion in adults are mainly due to the two mesenteric anatomical variations These include a long mesentery allowing the gallbladder and its associated cystic vessels to rotate along its axis, otherwise known as the “floating or pedunculated” gallbladder. In addition to gallbladder wall thickening and pericholecystic fluid, indicators of gallbladder torsion include a low-lying gallbladder below its usual anatomical fossa, conical or V shaped gallbladder, whirl sign of the cystic artery or bulls eye sign on hydroxyiminodiacetic acid (HIDA) scan [2]. The following case report is a typical presentation of gallbladder torsion, with supportive imaging and intraoperative images This case report highlights clinical features that help diagnose this rare condition which requires prompt surgical intervention.

Discussion

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Findings

Disclosures