A Case of Floating Gallbladder with Torsion of the Gallbladder and Herniation into Winslow's Foramen

Abstract

A 79-year-old woman was admitted to our hospital with a right upper quadrant pain 7 days before admission. Abdominal contrast-enhanced CT revealed a large distended gallbladder with an edematous wall without a lack of contrast and a whorled appearance at the neck of the gallbladder; the neck of the gallbladder was situated dorsal to the common bile duct. We suggested the possibility of a floating gallbladder with torsion of the gallbladder, and an emergency cholecystectomy was performed. The operative findings showed a Gross type Ⅱ floating gallbladder that had adhered to the transverse colon, duodenum, greater omentum, and hepatoduodenal ligament with herniation through Winslow's foramen and a 360-degrees counterclockwise torsion at the neck duct of the gallbladder. A histological examination of the gallbladder revealed partial necrosis of the epithelium. The possibility of gallbladder necrosis arising from torsion of the gallbladder should be kept in mind, and emergency surgery should be promptly performed. The further development of gangrenous cholecystitis is possible in patients with a floating gallbladder that exhibits both internal herniation and torsion of the gallbladder.