Acute gallbladder torsion: an unexpected intraoperative finding

Janakan, Gnananandan; Ayantunde, Abraham; Hoque, Happy

doi:10.1186/1749-7922-3-9

Cited by 41 publications

(92 citation statements)

References 8 publications

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“…16 Thus, early diagnosis and early intervention can reduce mortality associated with this condition. 16,17 Ultrasonography and computed tomography are nonspecific investigations for diagnosis of volvulus. 15 A hepatobiliary iminodiacetic acid (HIDA) scan theoretically shows a characteristic, though not sensitive, "bulls eyes" appearance of the torsed gall bladder.…”

Section: Discussionmentioning

confidence: 99%

Volvulus of gall bladder: case report

Kumar¹,

Hastir²,

Walia³

et al. 2017

Int Surg J

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Gall bladder volvulus or twisting is a rare condition and occurs due to rotation of gall bladder. Preoperative diagnosis is exception and usually misdiagnosed as cholecystitis before surgery. It is potentially fatal condition unless diagnosed and treated early leading to gangrene and biliary peritonitis. It has been reported in only about 500 cases in the literature ranging in age given 2-100 years old. We report a rare case of middle aged female 56 years old with volvulus of gall bladder having concomitant cholelithiasis treated with laparoscopic cholecystectomy.

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Section: Discussionmentioning

confidence: 99%

Volvulus of gall bladder: case report

Kumar¹,

Hastir²,

Walia³

et al. 2017

Int Surg J

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“…Torsion of gall bladder has mortality rate of 6% though no death occurred in patients diagnosed preoperatively [16]. Thus, early diagnosis and early intervention can reduce mortality associated with this condition [16,17].…”

Section: Discussionmentioning

confidence: 99%

Volvulus of Gall Bladder-Case Report and Review of Literature

Kumar¹,

Hastir²,

Ram³

et al. 2017

Surgery

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Journal of Surgery KeywordsGall bladder volvulus; Cholecystectomy; Torsion; Cholelithiasis IntroductionGall bladder volvulus is a rare and difficult to diagnose clinically as well radiologically was first described by Wendel in 1898 [1]. More than 400 cases are reported in literature [1,2]. Volvulus of gall bladder is more common in elderly females between 7 th and 8 th decades and female to male ratio of 3:1 [3]. Causes has been attributed to anatomical variations of gall bladder mesentry and loss of visceral fat, as well mesentery with cystic duct and artery known as floating gall bladder [4][5][6][7]. When there is strong peristaltic movement or when the stomach contracts, intestines may turn and curl the gall bladder. Morbidity and mortality reported are low among cases of gall bladder torsion that have been diagnosed and treated early [8]. Delayed or missed diagnosis and treatment increase patient mortality. Symptoms vary depending on severity of disease.Although recent advance in radiology help to diagnose many diseases, abdominal computed tomography (CT) and ultrasonography (USG) remains non-specific in diagnosing volvulus of gall bladder. Coronal magnetic resonance imaging (MRI) and magnetic resonance colangio-pancreatography (MRCP) and HIDA (hepatoiminodiacetic acid) scan are helpful in making the diagnosis of volvulus of gall bladder. We report as case of gall bladder volvulus with cholelithiasis treated by laparoscopic cholecystectomy and review of gall bladder volvulus. Case PresentationA 56 year old female reported in OPD with ultrasound diagnosis of acute cholecystitis with cholelithiasis. Patient was having history of pain for last 2 days which was dull and was associated with vomiting.Clinically patient was pyrexic with no acute distress with stable vital signs. Abdomen was soft, mildly distended and tenderness in right upper quadrant and a positive Murphy's sign.After routine investigations for laparoscopic cholecystectomy next day patient was taken up for surgery. Preoperative evaluation was unremarkable. On admission into operating room, patient was monitored with ECG, noninvasive blood pressure and pulse oximetre. Anasthesia was induced by 4.0 mg of midazolam and 5 mg of Scoline, muscles were paralyzed by 50 mg of atracurium. Endotracheal intubation 7.0 mm was placed into trachea to a depth of 20 cm from front teeth. Pure oxygen was used to mechanically ventilate the lungs. Laparoscopically we found distended rotated gall bladder with a complete mesentery which was large and allows the gallbladder to hang freely i.e., recognized situation 4 of gallbladder in relation to liver as discussed in detail in discussion. Surgery was uneventful after aspiration of clear fluid from gall bladder and derotation of gall bladder, laparoscopic cholecystectomy was done AbstractGall bladder volvulus or twisting is a rare condition and occurs due to rotation of gall bladder. Preoperative diagnosis is exception and usually misdiagnosed as cholecystitis before surgery. It is potentially fatal condition unless d...

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“…[3][4][5][6][7][8][9][10] The clinical incidence of GV has been reported as 1 in 365,520 hospital admissions. 11 Multiple authors have postulated reasons for torsion of the gallbladder. Boonstra suggested that GV only occurs in the absence of gallbladder fixation to the liver.…”

Section: Illustrative Casementioning

confidence: 99%

“…12 The term visceroptosis, referring to relaxation and atrophy of a previously normal mesentery in the elderly, has been used to describe this condition of mesenteric elongation and thinning, which is necessary for GV to occur. 11,[13][14][15][16][17] Atherosclerosis of the cystic artery and a tortuous cystic duct are also hypothesized as cofactors, as they may serve as fulcrums for gallbladder torsion. 3,17 Other investigators have noted coexisting conditions that may predispose to GV.…”

Section: Illustrative Casementioning

confidence: 99%