Expect the Unexpected: Torsion of the Gallbladder, a Rare Cause for Acute Cholecystitis

Hwang, Yang Ha; Kulendran, Krish; Ashworth, Jack

doi:10.7759/cureus.3726

Cited by 7 publications

(10 citation statements)

References 5 publications

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“…Otherwise, incomplete torsion is defined as the gallbladder rotated less than 180° (11). As torsion becomes complete, the GB's blood supply is directly affected, causing infarction and necrosis (12). In our study, 83% (n=5) of GT was complete and this would be comparable to the previous systematic review, which reports the 82% of GT were complete (11).…”

Section: Discussionsupporting

confidence: 79%

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

2021

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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.

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Section: Discussionsupporting

confidence: 79%

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

2021

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“…Originally described by Wendel in 1898 [1], gallbladder volvulus is a rare condition, with approximately 400 cases reported in the literature. Many of the documented cases initially described presentations similar to that of acute cholecystitis [2][3][4][5][6]. In 1982, Lau et al reviewed the clinical features of three cases where a definitive clinical pattern emerged, now defined as the triad of triads [7].…”

Section: Discussionmentioning

confidence: 99%

“…Gallbladder wall abnormalities, including the thickening and decreased wall enhancement found in the presence of ischemia, are best seen on a CT scan [ 8 ]. A horizontal gallbladder located outside of the gallbladder bed and torsion of the cystic pedicle, known as the “whirl sign,” are also two of the most helpful signs seen on CT scan [ 3 , 14 ]. As noted in Figure 1 , our patient was noted to have a horizontal gallbladder but there were no signs of ischemia, wall thickening, or torsion.…”

Section: Discussionmentioning

confidence: 99%

Gallbladder Volvulus Presenting as Acute Appendicitis

Shah

Ballecer

Hanna

et al. 2021

Cureus

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Gallbladder volvulus is a rarely reported and diagnosed condition. We present a case of an elderly female with right lower quadrant pain mimicking acute appendicitis without conclusive imaging; however, due to worsening serological laboratory findings and sepsis picture, an exploratory laparotomy was performed. A necrotic gallbladder was removed, diagnosing gallbladder volvulus. A systemic literature review showed the difficulty in making a diagnosis and the uniqueness of our patient presentation. A high level of clinical suspicion for gallbladder volvulus must be maintained and should be included in the differential diagnosis in elderly women with an acute abdomen, as complications can be severe.

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“…An abdominal CT scan with multi-plane CT reconstruction is a strong indicator of the diagnosis of a gallbladder volvulus. Most of the cases are described in older women with the following criteria: distended gallbladder, floating or pedunculated gallbladder, a beak or whirlpool signs at the cystic pedicle, low and horizontal laying of the gallbladder, thickened and non-enhanced gallbladder wall, and an absence of gallstones [ 1 , 2 , 11 - 13 ]. In one rare case, they reported gallbladder torsion diagnosed with sequential abdominal CT showing cystic duct rotated of approximately 180 degrees from the left to the right side of the gallbladder [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

A Gallbladder Volvulus Presenting as Acute Cholecystitis in a Young Woman

Đức

Van

Huy

2020

Cureus

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Gallbladder volvulus is rare and known to occur when there is a rotation of the gallbladder along the axis of the cystic vascular pedicle. Except for isolated cases reported in childhood, this disease is more frequently encountered in the elderly, especially in women. Therefore, most cases in the literature describe the clinical and radiographic features of gallbladder volvulus in this age group. In this subject, manifestations of abdominal pain are variable. Typically, right upper quadrant pain leads towards the diagnosis of cholecystitis, and diagnosis may be performed on imaging such as computed tomography (CT) scan with multi-plane CT reconstruction. However, preoperative diagnosis of gallbladder torsion remains difficult, and in most cases, especially in young women where it is rare, the clinical and radiographic features seem to differ from gallbladder torsion in the elderly. We report a case of gallbladder volvulus in a 26-year-old woman and review the clinical and radiological aspects of this disease.

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Expect the Unexpected: Torsion of the Gallbladder, a Rare Cause for Acute Cholecystitis

Cited by 7 publications

References 5 publications

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

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

Gallbladder Volvulus Presenting as Acute Appendicitis

A Gallbladder Volvulus Presenting as Acute Cholecystitis in a Young Woman

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