2019 Volume 39 Issue 7 Pages 1275-1278
The patient was a 71-year-old woman who visited our hospital complaining of abdominal pain. She had undergone right colectomy, and physical examination revealed a surgical scar measuring 150 mm in length on the right side of the abdomen. Abdominal CT showed edema-like change of the gallbladder, bile duct dilation, and a high-density lesion on the papilla of Vater. Therefore, additional MRCP and ENBD angiographic imaging were performed. MRCP showed no common bile duct stone or tumor, while cholangiography during ENBD angiography showed discontinuity of the cystic duct. Based on these findings, the patient was diagnosed as having gallbladder torsion, and emergency surgery was performed. Because the presence of severe adhesions on the right side of the abdomen was confirmed, the ports for laparoscopic surgery were positioned at the umbilicus, epigastrium, and left abdomen. The gall bladder was congested and twisted 180 degrees counterclockwise (Gross type Ⅱ gallbladder torsion）. The operation time was 92 minutes, the bleeding volume was small, and the postoperative course was good. The patient was discharged on day 6 after the onset of symptoms. In the present case, we found severe adhesions; however, laparoscopic cholecystectomy was made possible by appropriate positioning of the ports according to the location of the adhesions. This case is reported herein, with a consideration of the pertinent literature.
