Abstract
BackgroundGallbladder volvulus is a rare pathology first reported by Wendel in 1898. Although the main pathological process associated with gallbladder volvulus is not known, there is clinical evidence suggesting that lack of gallbladder adhesions to the liver leads to an eventual twisting around the cystic bile duct (a process that seems to favor older female populations).Case presentationIn this report, an 81-year-old Caucasian elderly female presented to the emergency department with acute/severe right upper quadrant pain, which was also accompanied by an elevated leukocyte count. Relevant imaging showed a distended gallbladder with gallbladder wall thickening and a dilated common bile duct. The patient was subsequently admitted to the hospital for acute cholecystitis and scheduled for surgery the next day. Upon laparoscopic surgery, the gallbladder was black and gangrenous with no visible adhesions to the liver. Further inspection demonstrated that the gallbladder had twisted clockwise around the cystic bile duct.ConclusionsWhile many previous cases have been reported since Wendel, further case studies are nevertheless important to help guide proper clinic evaluation and pinpoint the potential for a gallbladder volvulus.
Highlights
Gallbladder volvulus is a rare pathology first reported by Wendel in 1898
While many previous cases have been reported since Wendel, further case studies are important to help guide proper clinic evaluation and pinpoint the potential for a gallbladder volvulus
Diagnosis proves challenging as imaging is consistent with acute cholecystitis, with lab studies offering even less of a complete picture [4, 5]
Summary
A volvulus/torsion of the gallbladder is a rare pathology involving an elderly female with weight loss. The presentation mimics acute cholecystitis both on radiological examination and laboratory evaluation. While these modalities are not conclusive by themselves, the summation of their parts allows for the diagnosis of gangrene and possible volvulus of the gallbladder
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