Complete gallbladder torsion diagnosed with sequential computed tomography scans: a case report

Abstract

IntroductionTorsion of the gallbladder is an extremely rare cause of acute abdomen, which commonly affects thin elderly women. A prompt surgical approach is necessary to avoid fatal complications associated with gangrene and perforation of the gallbladder. However, it is difficult to make a preoperative diagnosis using ordinary imaging modalities.Case presentationAn 84-year-old Japanese woman was admitted to our hospital due to left lower abdominal pain. Her pain shifted suddenly to the right upper abdomen a half day after admission. Although her enlarged and wall-thickened gallbladder had been already seen at admission, it rotated approximately 180 degrees and deviated to the midline of her abdomen on the second computed tomography scan, which helped us to make a correct diagnosis of gallbladder torsion. The patient underwent an emergency operation (detorsion and cholecystectomy) and recovered without any complications. The gallbladder had necrosis due to torsion.ConclusionSequential diagnostic imaging might be helpful to make a preoperative diagnosis of gallbladder torsion when the gallbladder is enlarged and wall thickened but the patient does not present with typical clinical symptoms.

A Case of Torsion of the Gallbladder Suspected with SPECT-CT: Review and Recommendations

“…Few reports have used HIDA scintigraphy, and in majority of the cases, the gallbladder was completely excluded [4]. This particular case emphasized the necessity for comparing the imaging findings as a crucial step for the diagnosis of torsion [8,10].…”

“…Patients usually present with signs and symptoms suggesting cholecystitis [2,[6][7][8]. Gallbladder volvulus may also mimic other abdominal pathologies such as tumour of the gallbladder, appendicitis, enterocolitis, and small or large bowel occlusion [9,10]. The etiology of the torsion always implies an anatomic abnormality that causes the gallbladder to twist [4,6,9].…”

“…Even if the gallstones are detected, impaction of a stone is not present in gallbladder volvulus [2,8]. Other diagnostic criteria for this condition include a horizontal displaced rather than vertical long axis of the gallbladder, an eccentric location of the gallbladder out of the liver fossa, a lateralized cystic duct to the right of the gallbladder, and fluid between the gallbladder and the gallbladder fossa of the liver [10]. In addition, Doppler ultrasound and contrast-enhanced CT may demonstrate the absence of blood flow in the wall of the gallbladder [5].…”

Gallbladder Volvulus in a Patient with Type I Choledochal Cyst: A Case Report and Review of the Literature

“…T2-weighted MRI images are useful for evaluating necrosis of the gallbladder wall as in cases of torsion [ 19 , 20 ]. More recent reports have suggested the use of chronological and sequential diagnostic imaging as a means of diagnosing gallbladder torsion [ 21 ]. The present case illustrates the usefulness of comparing imaging from prior admissions in order to make the preoperative diagnosis of gallbladder torsion, which can be appreciated retrospectively ( Figure 1 ).…”

How to apply clinical cases and medical literature in the framework of a modified “failure mode and effects analysis” as a clinical reasoning tool – an illustration using the human biliary system

“…Perforation – other causes can be Epstein–Barr virus [10], liver abscess [11], blunt abdominal trauma [12], and spontaneous [13]Bile leaked into the peritoneum [9]Umbilical pain and a bluish discoloration of the skin around a known umbilical hernia presumably due to tracking of bile within the abdomen [9]Liver function test, laparotomy [9]The patient had spontaneous acalculous gallbladder perforation [9]. This condition is rare but criticalGallbladder herniation: parastomal [14–18], incisional [19–21], spontaneous ventral [22, 23], epigastric [24], transdiaphragmatic herniation [25]A midline abdominal hernia with small bowel loops, and a parastomal hernia containing the gallbladder [14]Abdominal pain [14]CT scan with oral Gastrograffin (sodium diatrizoate and meglumine diatrizoate) contrast [14]Gallbladder torsion [17]Torsion of the neck of the gallbladder with secondary suppuration leading to gangrenous changes in the gallbladder [17]Abdominal pain [17]Abdominal CT [17]Other case of gallbladder torsion [26], a new case of gallbladder torsion within an incisional hernia [27], complete gallbladder torsion [28], gallbladder torsion caused acute cholecystitis [7]A gallstone enters via the Vater papilla and later increases in size [29]Transition of a gallstone in the gastrointestinal tract leading to mechanical bowel obstruction (gallstone ileus) [29]Nausea, vomiting and abdominal pain [29]Abdominal CT, MRCP [29]Other case: gallbladder-colon fistula [30] and cholecystogastric fistula [31]Biliary-enteric fistula e.g. gallbladder-duodenal fistula [8]“Spontaneous biliary fistulas have been associated with gallbladder cancer; if they are the cause of cancer, or acomplication of it, this has not yet been defined.” [8]1-month history of episodic nausea and vomiting, and epigastric pain on admission [8]Abdominal ultrasound, CT, barium study [8]Failure of the cystic bud to develop in utero [32]Gallbladder...…”