Torsion of the gall-bladder

Abstract

SENIOR RESIDENT OPFICER, BRISTOL ROYAL INFIRMARYALTHOUGH torsion of the gall-bladder is reputed to be a rare condition, it ought not to be left out of mind by the surgeon. We have had three cases under our care within the past four years, so it seems probable, as with other so-called ' rare ' conditions, that a good many cases go unreported. Four surgeons have reported two each, and one (Henschen, of St. Gall) has seen three.We believe that it should often be possible to make a diagnosis before operation, and if this is done it will probably open the way to save the patient's life by timely surgery.Although nine cases have been described by British surgeons in addition to our own, there does not appear to be any detailed account of this disease in English literature, and widely read text-books of surgery which we have consulted make little or no reference to it. HISTORYThe first case on record was published by A. V. Wendel in America in 1898, and is, with one exception, the youngest patient reported ; also it is the only one in which the gall-bladder perforated. Ten years later, three cases were described from Germany. The best descriptions of acute torsion of the gall-bladder are those of A. M. Shipley (American), P. Costantini (Italian), and P. Brocq (French).

Volvulus of the gall bladder diagnosed by ultrasonography, computed tomography, coronal magnetic resonance imaging and magnetic resonance cholangio-pancreatography

“…It occurs in all age groups, with the highest incidence in elderly women, and a female-to-male ratio of 3:1. Perhaps the incidence would increase with a longer life expectancy rate [2,3] . Gallstones are unlikely to be the cause of gallbladder torsion, as gallstones are not uniformly present in all patients reported with torsion.…”

Torsion of the gall bladder

“…Short and Paul (1934) consider it feasible and Krabbel (1920) and Kettner (1930) have made it correctly. The characteristic features are said to be acute pain in the right upper abdomen, perhaps colicky in nature, associated with vomiting and the presence of a sharply demarcated area of localized tenderness, together with a mass which might come and go.…”

Two cases of acute torsion of the gall bladder.

“…Few (Short and Paul, 1934;Rawson, 1953) have diagnosed correctly before operation, although the former authors were confident that a pre-operative diagnosis could often be made. I, however, agree that their (Short and Paul, 1934) remarks about the diagnostic criteria are commendable.…”

“…Few (Short and Paul, 1934;Rawson, 1953) have diagnosed correctly before operation, although the former authors were confident that a pre-operative diagnosis could often be made. I, however, agree that their (Short and Paul, 1934) remarks about the diagnostic criteria are commendable. They wrote: 'A pre-operative diagnosis could often be made, the grounds being the occurrence of pain, vomiting, especially in an elderly female with a palpable tumour having the characters of a gall bladder which comes up within a few hours and may appear and disappear.'…”