J Korean Surg Soc.  2013 Dec;85(6):302-304. 10.4174/jkss.2013.85.6.302.

Torsion of the gallbladder in pregnancy

Affiliations
  • 1Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea. selee508@cau.ac.kr
  • 2Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Abstract

Torsion of the gallbladder is a rare condition that is difficult to diagnose preoperatively, but prompt surgical intervention is necessary to avoid possible sepsis and death. A 36-year-old pregnant woman presented to Emergency Department with a constant epigastric pain at 17 weeks of gestation. Abdominal ultrasonography and magnetic resonance imaging demonstrated a distended gallbladder that contained no stones but had mild wall thickening. Laparoscopic cholecystectomy using three ports was performed under the impression of an acalculous cholecystitis. The gallbladder was found to be rotated 180 degrees clockwise on gallbladder mesentery and to be gangrenous. The postoperative course was uneventful and the patient was discharged on the 4th day after surgery. It is important to keep in mind gallbladder torsion in the differential diagnosis from acute cholecystitis when the patient has an acute onset of abdominal pain and a severely distended gallbldder. Prompt cholecystectomy via a laparoscopic approach should be performed.

Keyword

Gallbladder; Torsion abnormality

MeSH Terms

Abdominal Pain
Acalculous Cholecystitis
Adult
Cholecystectomy
Cholecystectomy, Laparoscopic
Cholecystitis, Acute
Diagnosis, Differential
Emergencies
Female
Gallbladder*
Humans
Magnetic Resonance Imaging
Mesentery
Morphinans
Pregnancy*
Pregnant Women
Sepsis
Torsion Abnormality
Ultrasonography
Morphinans

Figure

  • Fig. 1 Preoperative magnetic resonance imaging. This scan showed a slightly distended gallbladder with a markedly edematous and multilayered wall.

  • Fig. 2 Operative findings. The gallbladder which was gangrenous and the body of which had rotated 180° clockwise on the gallbladder mesentery was derotationed. Arrow pointed the rotational axis of body of the gallbladder.

  • Fig. 3 Magnetic resonance cholangiography imaging. This scan showed a slight v-shaped distortion of the extrahepatic bile ducts (arrow).


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