J Korean Surg Soc.  2009 Aug;77(2):143-148. 10.4174/jkss.2009.77.2.143.

Gallbladder Torsion with Accompanying Acute Appendicitis

Affiliations
  • 1Department of Surgery, Gumi CHA Hospital, College of Medicine, Pochon CHA University, Gumi, Korea. kee39surgeon@sendu.com
  • 2Department of Diagnostic Radiology, Gumi CHA Hospital, College of Medicine, Pochon CHA University, Gumi, Korea.
  • 3Department of Emergency Medicine, Gumi CHA Hospital, College of Medicine, Pochon CHA University, Gumi, Korea.

Abstract

Gallbladder torsion is a rare clinical entity and it is a difficult condition to diagnose preoperatively. About 500 cases of gallbladder torsion have been reported since 1898, when Wendel first described gallbladder volvulus. This condition most commonly occurs in elderly women and the symptoms of this disease are largely non-specific and they mimic those of acute cholecystitis. Even with the recent advances of radiologic imaging modalities, making a preoperative diagnosis of gallbladder torsion is difficult and most cases are diagnosed at the time of surgery. An early diagnosis and prompt cholecystectomy for this disease are important in order to avoid the complications of gangrene and perforation, and to reduce mortality. A high index of suspicion of gallbladder torsion on the basis of the clinical situation and the specific findings on the radiologic images, usually ultrasonography and computed tomography (CT) scanning, can make the correct preoperative diagnosis possible. Gallbladder torsion is a rare disease, and gallbladder torsion with accompanying acute appendicitis is extremely rare. We report here on a case of gallbladder torsion with accompanying acute appendicitis in an 89-year-old woman and we review the clinical aspects of gallbladder torsion. Unfortunately, the diagnosis of gallbladder torsion was missed in this case, so we retrospectively reviewed and correlated the CT findings with the surgical findings.

Keyword

Gallbladder torsion; Acute appendicitis; Computed tomography

MeSH Terms

Aged
Aged, 80 and over
Appendicitis
Cholecystectomy
Cholecystitis, Acute
Early Diagnosis
Female
Gallbladder
Gangrene
Humans
Hydrazines
Intestinal Volvulus
Rare Diseases
Retrospective Studies
Hydrazines

Figure

  • Fig. 1 The contrast-enhanced CT scan shows a markedly distended gallbladder with a thickened wall (white arrows) and a dilated extrahepatic bile duct without any definite obstructing lesion (black arrow) (A, B), and an inflamed appendix is seen in the retrocecal area (arrowhead) (B).

  • Fig. 2 Operative findings. A very large, distended and gangrenous gallbladder was found in the upper abdomen; the gallbladder was not attached to the liver bed and it was rotated around the junction of the neck of the gallbladder and the cystic duct (A). After detorsion (B).

  • Fig. 3 The contrast-enhanced CT scan shows a tapered cystic duct (arrowheads) that had no obvious continuation with the gallbladder lumen and there are crowded mesenteric and cystic arteries (white arrows) with a retracted contour of the medial border of the S5 segment of the liver (black arrow) (A). The coronal reformatted CT image shows a floating, markedly distended gallbladder with a diffusely thickened wall (arrows) and a poorly enhanced mucosal layer (arrowheads) of the neck (B). The curved multi-planar reformation image shows twisted mesenteric and cystic arteries (arrowheads) with a retracted liver surface (white arrow) of the S5 segment. An inflamed appendix (black arrow) is noted in the retrocecal area (C).

  • Fig. 4 Photograph of the resected gallbladder and appendix. The resected gallbladder has a thickened edematous wall with gangrenous changes and there are no stones in the gallbladder lumen (A). The resected appendix has an edematous wall (B).


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