A comparative analysis of gallbladder torsion and acute gallbladder disease without torsion: a single-center retrospective case series study

Abstract

Background: Acute gallbladder disease (AGD) is frequent in the emergency department (ED), and usually requires surgical intervention. Gallbladder torsion (GT) is a rare entity among patients with AGD. There are sparse reviews of GT's clinical characteristics, and there is no comparative study between them in the same patient cohort. Therefore, we report the case series of GT, and compare the statistical differences between GT and non-GT with AGD.Methods: We collected retrospective data from patients who visited ED with AGD and underwent emergency cholecystectomy between January 2005 and December 2020. We combined consecutive case series of GT and compared them with non-GT gallbladder disease.Results: Six GT cases were diagnosed over the study duration. Five were female (83%) and the average age was 77.8 years. All patients presented with abdominal pain, and the median duration of pain was two days.Only two cases were suspected for GT pre-operatively (33%). One patient underwent laparotomy, and the others underwent laparoscopic cholecystectomy with a mean operation time of 59 min. The torsion direction was of the same proportion in both directions; five (83%) were rotated completely. The mean length of hospital stay was 9.3 d and outcomes were favorable in most GT cases. In the comparative study between GT and non-GT, age was higher in the GT group (P=0.048), and duration or severity of pain showed no statistical difference (P=0.528; P=0.637, respectively). Body temperature was higher in the non-GT group without statistical significance (P=0.074). Gallstones were present in 68.8% of the non-GT group, which is significantly higher than that of the GT group (P=0.036).Conclusions: Six exceptional GT cases were managed successfully. The overall characteristics of each GT case demonstrated similar with previous reviews. Our comparative analysis showed that age, pulse rate, serum creatinine level, and gallstone presence showed statistical differences. Contrary to the traditional knowledge of GT, some distinct features like sex, duration or severity of pain, and fever showed no significant differences within AGD in our research.

Gallbladder Torsion: A Rare but Critical Diagnosis

“… 4 The prevalence of gallstones in gallbladder torsion is significantly less than those with acute gallbladder pathology without torsion. 8 Ultrasound and CT may also demonstrate abnormal positioning of the gallbladder, such as with a transverse orientation or a twisted vascular pedicle or cystic duct to the right of the distended gallbladder. 4 The presented case demonstrated transverse orientation of the gallbladder with the fundus directed towards the left hemiabdomen as opposed to the right.…”

Necrotizing Gallbladder Torsion Masking as Acalculous Cholecystitis: A Review of Two Cases Treated with Successful Laparoscopic Cholecystectomy

“…Wendel [5] in 1898. 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 [6]. Adult women are reportedly more affected than men, with a 3:1 female to male ratio [4].…”

Impact of COVID-19 outbreak on acute gallbladder disease in the emergency department

“…This secondary referral center is a level 1 regional ED in Korea, and the annual number of emergency cholecystectomies at the institution ranges from 300 to 350. 19 Patients who were managed during the 6-month period after the COVID-19 outbreak from March 1 to August 31, 2020, were defined as the post-COVID group, whereas the pre-COVID group consisted of patients who were managed during the same period in the previous year from March 1 to August 31, 2019. The study was approved by the Institutional Ethics Review Board of CHA Gumi Medical Center (No.…”

“…The retrospective cohort study was conducted at an academic teaching hospital (CHA University Gumi Medical Center, Gumi, Korea). This secondary referral center is a level 1 regional ED in Korea, and the annual number of emergency cholecystectomies at the institution ranges from 300 to 350 [ 19 ]. Patients who were managed during the 6-month period after the COVID-19 outbreak from March 1 to August 31, 2020, were defined as the post-COVID group, whereas the pre-COVID group consisted of patients who were managed during the same period in the previous year from March 1 to August 31, 2019.…”