Abstract
A 98-year-old woman complaining of abdominal pain and vomiting was referred to our hospital with a diagnosis of ileus. The patient's abdomen was tender, and the CRP value was elevated to 26 mg/dl. The WBC count was 10500/ul. Hepatic and renal cysts and a dilated bowel were observed on abdominal CT scans, but there was no evidence of strangulation. Because the patient was a PS4, a person of advanced age, for whom surgery entailed great risk, she was treated conservatively and her clinical course was monitored. However, she went into shock on the next day and, emergency surgery was performed after consultation with her family. The intraoperative findings showed torsion of a necrotic gallbladder which had displaced to the lateral side of the right kidney. The necrotic gallbladder was excised, and the patient was discharged on the hospital day 9. What appeared to be a dilated bowel on the preoperative CT scans was clarified to be a twisted gallbladder. Careful differential diagnosis is necessary for patients who have hepatic cysts as well as paralytic ileus.
