Incidental Finding of Gallbladder Torsion During Laparoscopic Cholecystectomy.

Stephen Doxey,Perwaiz Nawabi,Charles Harper,Corey Pagnotta,Joshua Gazzetta,Sally Smith

doi:10.7759/cureus.18058

Stephen Doxey, Perwaiz Nawabi + Show 4 more

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https://doi.org/10.7759/cureus.18058

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Abstract

Laparoscopic cholecystectomy is a common general surgery procedure, with over a million laparoscopic cholecystectomies performed in the United States annually. A rare presentation, which may be encountered incidentally during surgery, is torsion of the gallbladder. Gallbladder torsion is encountered in 0.01% of all patients with acute cholecystitis. It should be considered in the differential diagnosis of elderly female patients presenting with symptoms of acute or chronic cholecystitis. In this case report, we discuss the incidental finding of gallbladder torsion during laparoscopic cholecystectomy in an 82-year-old female admitted to the hospital with symptoms of cholecystitis. Preoperative CT imaging revealed a chronic, large hiatal hernia and a dilated gallbladder containing heterogeneous densities, possibly related to sludge. During the operation, a necrotic, torsed gallbladder and long cystic duct were found. A laparoscopic cholecystectomy was performed and the remainder of the patient’s hospital course was uncomplicated.Intraoperatively, our patient was found to have torsion of the gallbladder. Preoperative lab values revealed mild hyponatremia, hypokalemia, and hypochloremia with normal liver enzymes, bilirubin, and alkaline phosphatase levels. This is consistent with documented cases, as typically the biliary tree is not obstructed. Additionally, preoperative imaging rarely reveals the diagnosis. Prompt detorsion and cholecystectomy should be performed to prevent gangrene and perforation.Gallbladder torsion can result in perforation if not quickly identified and treated. We recommend prompt laparoscopic detorsion and cholecystectomy to prevent perforation.

Highlights

Laparoscopic cholecystectomy is a common general surgery procedure, with over a million laparoscopic cholecystectomies performed in the United States annually [1]
This may help explain why the highest incidence of gallbladder torsion occurs in the elderly population, with 85% of cases occurring in people between the ages of 60 and 80 years old
Gallbladder torsion is a rare disorder primarily seen in elderly women

Summary

Introduction

Laparoscopic cholecystectomy is a common general surgery procedure, with over a million laparoscopic cholecystectomies performed in the United States annually [1]. A rare and often incidental presentation, encountered in 0.01% of all patients with acute cholecystitis, is torsion of the gallbladder [2]. The etiology of gallbladder torsion is not entirely clear, but there are two common predisposing anatomical factors: a mesentery that supports only the cystic duct and artery, and a wide mesentery. Liver atrophy and loss of visceral fat due to aging can lead to an acquired anatomical predisposition to gallbladder volvulus This may help explain why the highest incidence of gallbladder torsion occurs in the elderly population, with 85% of cases occurring in people between the ages of 60 and 80 years old. The patient is an 82-year-old female who underwent laparoscopic cholecystectomy She initially presented to the hospital with abdominal pain, nausea, and vomiting. Intraoperative findings revealed a long cystic duct and a necrotic gallbladder

Discussion

Conclusions

Disclosures

Findings

Wendel AV