Gallbladder torsion within incisional hernia: an original cholecystitis

Abstract

Gallbladder torsion with ischemic wall necrosis is a rare condition, as gallbladder herniation. We describe here an original case of a patient with a symptomatic incisional hernia containing a gangrenous gallbladder twisted about its pedicle. We report preoperative findings on CT-scan and emergency surgical management.

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...…”