EP.TU.972Torsion of the gallbladder: a rare disease

Gallbladder torsion was first described as early as in the 19th century but there are only about five hundred cases reported in literature. This rare disease predominantly affects elderly women with a median age of 77 years.The female to male ratio is 4:1. Though the exact etiology is unknown, certain anatomical variants of the gallbladder are thought to increase one's predisposition to the condition. Gallbladder torsion is very difficult to diagnose preoperatively and even with all the advancements in imaging techniques, only about a quarter of cases are diagnosed preoperatively. Most cases like the index case are diagnosed during surgery Aim To review the diagnosis and management of gallbladder torsion in 78 year old female patient who presented acutely to our unit. Method Discussion on the presentation, assessment, imaging and preoperative findings to as well as the management plan adopted. Results A review of intraoperative findings, postoperative recovery of the patient and literature on gallbladder torsion. Conclusion Since the first case of laparoscopic cholecystectomy for torsion in 1994, 105 further cases have been reported. Of this, 28% were managed by laparoscopic surgery whilst 8% resulted in a laparoscopy converted to open procedure. one case of ERCP detorsion has been reported. A high index of suspicion together with improved imaging techniques can help to significantly improve the preoperative diagnosis of gallbladder torsion. Early operative management usually results in a good prognosis. Innovations imaging techniques to help improve preoperative diagnosis will be discussed.

Acute Cholecystitis due to a gall bladder torsion: A case report

Gallbladder torsion is an unusual cause of an acute abdomen that can be mortal. It mimicks commonly acute cholecystitis. Its diagnosis is challenging for surgeons. Once it is suspected, prompt surgical treatment must be carried out, which is detorsion with cholecystectomy.

Gallbladder and Liver Lobe Torsion in a Young Cat Presented with Hemoabdomen

ABSTRACT An 11 mo old domestic shorthair presented with acute lethargy. The cat was hypothermic and bradycardic and had pale pink mucous membranes, poor pulses, and a distended abdomen. Point-of-care ultrasound identified significant abdominal effusion, which was diagnosed to be a hemoabdomen. Bloodwork revealed hyperlactatemia, regenerative anemia, neutrophilia, hypoproteinemia, hypoalbuminemia, and increased alanine aminotransferase. The cat received an allotransfusion and a subsequent canine xenotransfusion and received further supportive therapy. After stabilization, abdominal ultrasonography diagnosed a gallbladder and liver lobe torsion with hemoabdomen. Exploratory laparotomy confirmed the torsion of the right medial and quadrate hepatic lobes together with the gallbladder. Cholecystectomy and lobectomy of the affected lobes were performed using a surgical stapler. The cat was discharged after 4 days. Histopathology confirmed hemorrhagic infarction of the liver lobes and gallbladder, consistent with the described torsion, and the hepatic pseudocyst. It also demonstrated a mucocele in the gallbladder. One month postoperatively, the cat had totally recovered. Hepatic lobe torsion without neoplasia is a rare disease in cats, with variable clinical signs. Gallbladder torsion is a hitherto unreported condition in cats. This is the first report of gallbladder and liver lobe torsion with secondary hemoabdomen in a cat, successfully treated by one-stage surgery.

Torsion of the gallbladder: a rare but important differential to consider when treating acute cholecystitis non-operatively

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.