TRUSION OF THE GALLBLADDER SUCCESSFULLY DIAGNOSED BY MRCP PREOPERATIVELY-REPORT OF A CASE-

Abstract

An 83-year-old woman was seen at the hospital because of general fatigue and right upper abdominal pain. On physical examination, a 10×8cm wellmovable tumor was palpated in the right upper abdomen. Ultrasonography revealed the swollen gallbladder, and whole-circumferentially thickened wall. CT revealed the gallbladder situated just beneath the medianabdominal wall. DIC disclosed a slight dilatation of the common bile duct, but no gallbladder was visualized. In order to clarify the anatomical correlation between the gallbladder and common bile duct, MRCP was conducted. MRCP revealed that the gallbladder displaced internally and posteriorly at the neck, the displacement of the gallbladder being clearly visualized. The diagnosis of trusion of the gallbladder was made. At laparotomy, the gallbladder was dark-red in color and was twisted clockwise by 180 degree. A simple cholecystectomy was performed.
In a review of 267 cases in the Japanese literature, the disease commonly occurs in women in their seventies and these patients have fever in a low frequency compared with those with acute abdomen. Clinical cases diagnosed as trusion of the gallbladder preoperatively represented 11.2% of all cases, but it has increased to 23.5% in a recent one decade. In the diagnosis of the disease, our through knowledge of US and CT findings as well as MRCP may become reliable methods to make the definite diagnosis of the disease.