Abstract
Torsion of the gallbladder was described in 1898 by Wendel, and is a relatively rare condition. It is more often found in elderly female patients. We present two cases of complete torsion of the gallbladder and one case of incomplete torsion of the gallbladder treated at our hospital.
Case 1: An 85-year-old woman complaining of right hypochondralgia with a high fever and vomiting was admitted to our hospital. An abdominal examination revealed localized tenderness and fullness in the right abdomen without guarding and rebound tenderness. Ultrasonography revealed a large cystic mass with a thickened wall in the right abdominal cavity. The presumptive diagnosis was acute cholecystitis or periappendicular abscess. The patient was operated on 64 hours later. The bladder exhibited a 180° counterclockwise rotation with complete gangrene. The gallbladder was attached to the liver by a narrow mesentery at its neck. After derotation, cholecystectomy was performed. No gallstones were found inside the gallbladder.
Case 2: A 69-year-old man suffering from right hypochondralgia with nausea and vomiting after the second postoperative day since he had undergone a radical operation for a left indirect inguinal hernia. A physical examination revealed localized tenderness in the right upper quadrant with rebound tenderness. Ultrasonography demonstrated a distended gallbladder with a thickened wall. From our experience of case 1, we suspected the lesion was torsion of the gallbladder. At operation, gangrenous gallbladder suspended only by a narrow mobile mesentery. The gallbladder had rotated 360° counterclockwise. Detorsion of the gallbladder was performed, followed by cholecystectomy. No gallstones were found inside the gallbladder.
Case 3: A 43-year-old man was admitted to our hospital with acute upper abdominal pain and vomiting. An abdominal examination revealed localized tenderness in the right upper quadrant without guarding and rebound tenderness. Subjective pain increased at the right decubitus position and upright position. Tenderness in the right upper quadrant shifted to the medial side at the left decubitus position. DIC showed ptosis and easy mobility of the gallbladder with posture changes. A few transient attacks subsided spontaneously. The presumptive diagnosis was incomplete torsion of the gallbladder. At operation, normal gallbladder suspended only by narrow mesentery. Cholecystectomy was performed. The postoperative course was satisfactory.
The possible predisposing factors of this disease include congenital anomalies of the gallbladder (floating gallbladder), visceroptosis and kyphosis. It has been considered difficult to make a preoperative diagnosis of this disease. If an elderly woman with kyphosis has signs and symptoms of acute cholecystitis, we can strongly suspect that she may be suffering from torsion of the gallbladder. An abdominal ultrasonic tomography may be a very useful means to diagnose this disease, if itreveals dilatation of the gallbladder with an narrowing of the neck as in case 1.
