TORSION OF THE GALLBLADDER A CASE REPORT

Abstract

A case of torsion of the gallbladder is reported. An 80-year-old woman presented with complaints of abrupt attack of right upper quadrant pain and nausea. On admission, a remarkably enlarged gallbladder was palpable, and tender. After a conservative period of observation and ineffective antibiotic therapy during which rebound tenderness worsened, we decided to operate under a provisional diagnosis of gangrenous cholecystitis and peritonitis, about 48 hours from onset. At laparotomy, the gallbladder was freely hanging in the peritoneal cavity and was twisted in a counterclockwise rotation about 270°. It was gangrenous but not perforated.
Among many acute abdominal diseases, torsion of the gallbladder is a relatively rare disorder of the biliary system, and should be promptly treated surgically. Most cases reported in the literature were diagnosed at laparotomy as in our case, but recently a few cases have been diagnosed preoperatively by means of ultrasonography and CT scanning. Accompanied by the development and prevalence of modern imaging procedures, more instances will be diagnosed noninvasively by these modalities in the future, and establishment of reliable diagnostic criteria consistent with this disorder, if possible, will allow early diagnosis and treatment.