Diagnosis and Laparoscopic Approach to Gallbladder Torsion and Cholelithiasis

García-Villa, Patricio Cruz; Álvarez, Jorge Fernández; Uzqueda, Gonzalo Vargas

doi:10.4293/108680810x12674612765588

Cited by 32 publications

(53 citation statements)

References 19 publications

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“…Lab investigations may be normal as in one case or leukocytosis maybe there. Liver function is normal as CBD remains unobstructed [14]. Preoperative diagnosis of gall bladder torsion is difficult since clinical features overlap with other acute gall bladder conditions [15].…”

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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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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“…11 Use of percutaneous drainage is only recommended when the surgical procedure could be high risk to patient. 24 …”

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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“…14,19 The extent of torsion, measured in degrees, can be used to differentiate between complete (>180 o ) and partial (<180 o ) torsion. 1,3,19 Incomplete volvulus may be misdiagnosed as biliary colic, whereas complete torsion produces unremitting, acute RUQ pain mimicking AC, and this ultimately results in infarction followed by perforation if not recognized promptly. 1,3,19 Clockwise torsion has been attributed to gastric peristalsis, whereas counterclockwise torsion has been linked to colonic peristalsis.…”

Section: Illustrative Casementioning

confidence: 99%

“…1,3,19 Incomplete volvulus may be misdiagnosed as biliary colic, whereas complete torsion produces unremitting, acute RUQ pain mimicking AC, and this ultimately results in infarction followed by perforation if not recognized promptly. 1,3,19 Clockwise torsion has been attributed to gastric peristalsis, whereas counterclockwise torsion has been linked to colonic peristalsis. 1, 16 Christoudias hypothesized that GV arising from visceral peristalsis alone is unlikely, given that 5% of the population has a "floating gallbladder" and the peristaltic movements of the gastrointestinal tract are continuous.…”

Section: Illustrative Casementioning

confidence: 99%

“…It is most frequently seen in women who are in their seventh and eighth decades of life. 1 This report will review the world literature on GV. We hope to shed light on the diagnosis of GV by highlighting typical clinical presentations and imaging studies from eclectic case reports, thereby bringing this pathology to the attention of the international medical community.…”

Section: Introductionmentioning

confidence: 99%

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