AI Article Synopsis
- * An 81-year-old woman presented with severe upper-right quadrant pain, nausea, and vomiting, with imaging showing no gallstones; emergency surgery revealed a completely twisted and necrotic gallbladder.
- * Recognizing the sudden onset of abdominal pain along with specific risk factors and imaging qualities can aid in diagnosing gallbladder torsion before surgery.
Article Abstract
Background: Gallbladder torsion or gallbladder volvulus is a rare condition of the hepatobiliary system, defined as a rotation of the gallbladder along its long axis causing an interruption of the vascular and biliary flow. It clinically mimics acute cholecystitis which makes accurate preoperative diagnosis challenging.
Case Description: We present the case of an 81-year-old woman with a three day history of upper-right quadrant pain, nausea, vomiting and no evidence of cholelithiasis on imaging. Emergency cholecystectomy was performed, intraoperative findings included a necrotic gallbladder with complete torsion. After the secondary diagnosis of gallbladder torsion, the clinical and radiologic findings were reviewed retrospectively.
Conclusion: The acute onset of abdominal pain without clear progression over time should initially be the trigger for differential diagnostic consideration of gallbladder torsion. This combined with the previously described risk factors and radiological characteristics could result in successful pre-operative diagnosis of gallbladder torsion.
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Gallbladder volvulus (GV) involves the rotation of the gallbladder along its axis, resulting in torsion. This pathology is rare, more commonly found in elderly females, but can occasionally occur in pediatric patients. Diagnosis is challenging due to often atypical symptoms, with imaging and laboratory findings typically nonspecific.
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- Volvulus of the gallbladder involves a rotation around its support structures, often linked to factors like anatomy and a distended gallbladder.* -
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- * Doctors effectively treated her condition using percutaneous drainage, avoiding surgery and its potential complications.
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Gallbladder torsion.
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At the time this article was written, Hayley M. Hamblin was a student in the PA program at Baldwin Wallace University in Berea, Ohio. She now practices in emergency medicine with US Acute Care Solutions at Summa Health System-Akron (Ohio) Campus. Amitabh Goel is chair of surgery and director of critical care at University Hospitals Geneva (Ohio) Medical Center. Jared R. Pennington is associate dean of health sciences in the College of Education and Health Sciences at Baldwin Wallace University. The authors have disclosed no potential conflicts of interest, financial or otherwise.
Article Synopsis
- Gallbladder torsion is a rare but serious condition that can lead to acute abdominal issues requiring surgical attention.
- Early diagnosis and timely surgical treatment are crucial to minimize complications and improve patient recovery, yet standard tests often do not clearly differentiate it from acute cholecystitis.
- The article outlines a specific case of gangrenous cholecystitis caused by torsion and provides recommendations for evaluating and managing this condition.
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