Villous adenoma in gallbladder volvulus: A rare coincidence.

Abstract

To the Editor,Gallbladder volvulus and gallbladder adenoma, espe-cially villous adenoma are rare clinical conditions. They are more common in elderly female patients. We re-ported in this case a patient with gallbladder adenoma and volvulus.An 80-year- old female admitted to our hospital with a sudden onset of right upper quadrant abdominal pain and vomiting that had worsened in hours. She had no abnormality in her medical history. She was conscious with a blood pressure of 110/70 mmHg. Her pulse rate was 96/min and body temperature was 37,2 oC. She had a sensitive palpable abdominal mass on right quadrant with positive Murphy sign on physical examination. She had neither leucocytosis nor other pathologies in la-barotory results. Abdominal ultrasonography revealed hydropic gallbladder with a size of 37x99 mm. She had concentrated bile sludge and multiple milimetric cal-culi in the gallbladder lumen. Sonographic signs with odematous and thickened gallbladder wall besides pel-vic free fluid around intestines led to the prediagnosis of acute cholecystitis. The patient refused hospitalization despite our insistence. On the following day, she admit-ted again with more severe abdominal pain, vomiting and fever. She had leucocytosis 13400 /uL. There was no change in her physical examination. We performed urgent laparotomy. A floating gangrenous gallbladder due to torsion was seen on laparatomy. It was not ad-hered to the liver or other adjascent tissues. It was cov-ered by omentum and it floated over intestines. It was rotated clockwise 360 degrees along mesentery axis (Figure 1). It was detorsioned, ductus cycticus and arte-ria syctica were prepared and resected. The gallbladder was 11x5x3.5 cm in size and there was a 2.5x2x1 cm vil-lous adenoma at the cervical region of gallbladder and a hemoragic infarct on the other region without any calculi on histopathological evaluation (Figure 2). She was discharged on the third day of operation without any complication. Gallbladder volvulus is a rare cause of acute abdomi-nal pain. It seems to be more common in elderly thin female patients as our patient (1,2). In recent years, the incidence seems to be increasing probably due to lon-ger life.