Torsion of the gallbllader is a rare disease which is difficult to diagnose preoperavility, because of its non-specific symptomes Most of patients with this disease are operated on with a diagnosis of acute cholecystitis, peritonitis or appendicitis.
Recently, owing to the development of modern imaging procedures, a few cases in the Japanese literatures were diagnosed preoperavility.
An 82-year-old man complaining of right hypochondriac pain was found to have remarkable abdominal tenderness and defense. Ultrasond examination demonstated a swollen gallbllader with thickened wall and a small amount of ascites. Subsequent computed tomography visualized the constriction at the gallbllader neck. We attempted percutaneous transhepatic cholecystography to obtain further information. The first puncture demonstrated the bird beak sign at the distal part of the constricted portion of the gallbllader. The cystic and common bile duct were visualizedby the second puncture at the proximal part of constriction. Operation was performed one day after the onset, with suspicion of torsion of the gallbllder because of the bird beak sign. At operation, the congestive and swollengallbllader was found to be twisted clockwise by 210° to 240° at the nwck. Pathological features of the resected gallbllader specimen were compatible with diagnosis of gallbllader torsion.
It is anticipated that percutaneous transhepatic cholecystography may yield an increasing number of accurately diagnosed cases of gallbllader torsion before operation. Because of the risks of complications from the puncture procedure, the surgeon should be prepared for prompt operation.
