Chai JS, Wang X, Li XZ, Yao P, Yan ZZ, Zhang HJ, Ning JY, Cao YB. Presentation of gallbladder torsion at an abnormal position: A case report. World J Clin Cases 2020; 8(12): 2667-2673 [PMID: 32607348 DOI: 10.12998/wjcc.v8.i12.2667]
Corresponding Author of This Article
Jia-Sui Chai, MD, Doctor, Research Fellow, Attending Surgeon, Department of Hepatobiliary Surgery, Yuncheng Central Hospital, the Eighth Clinical College of Shanxi Medical University, Hedong Street, Yuncheng 044031, Shanxi Province, China. chaijiasui@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jia-Sui Chai, Xu Wang, Xiao-Zheng Li, Peng Yao, Hong-Jie Zhang, Jia-Yong Ning, Yan-Bing Cao, Department of Hepatobiliary Surgery, Yuncheng Central Hospital, the Eighth Clinical College of Shanxi Medical University, Yuncheng 044031, Shanxi Province, China
Zheng-Zheng Yan, Department of General Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan 030032, Shanxi Province, China
Author contributions: Chai JS, Wang X, Zhang HJ, and Ning JY performed the preoperative evaluation and diagnosis; Chai JS, Wang X and Li XZ performed the surgery; Chai JS, Yan ZZ, Ning JY and Cao YB reviewed the literature and contributed to drafting the manuscript; and all authors issued final approval for the submitted version.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jia-Sui Chai, MD, Doctor, Research Fellow, Attending Surgeon, Department of Hepatobiliary Surgery, Yuncheng Central Hospital, the Eighth Clinical College of Shanxi Medical University, Hedong Street, Yuncheng 044031, Shanxi Province, China. chaijiasui@163.com
Received: February 22, 2020 Peer-review started: February 22, 2020 First decision: May 1, 2020 Revised: May 9, 2020 Accepted: May 27, 2020 Article in press: May 27, 2020 Published online: June 26, 2020 Processing time: 123 Days and 4.6 Hours
Abstract
BACKGROUND
Gallbladder torsion is a rare acute abdominal condition that requires emergency surgery. It occurs more commonly in elderly people and in women in the adult population. Diagnosis is a challenge as non-specific symptoms and signs have been reported on ultrasonography, computed tomography and magnetic resonance imaging. Prompt cholecystectomy can decrease the mortality and morbidity of perforation due to gallbladder torsion.
CASE SUMMARY
An 82-year-old woman with upper-right quadrant pain and associated nausea and vomiting was diagnosed with ectopic acute calculus cholecystitis. Magnetic resonance cholangiopancreatography (MRCP) showed a V-shaped distortion of the extrahepatic bile ducts and a particularly extended twisted cystic duct, which indicated the presence of gallbladder torsion. Emergency laparoscopic cholecystectomy confirmed the diagnosis and the patient recovered without incident.
CONCLUSION
Gallbladder torsion can be diagnosed pre-operatively by MRCP. The specific signs are a V-shaped distortion of the extrahepatic bile ducts and a particularly extended twisted cystic duct which can be called twisting signs.
Core tip: Gallbladder torsion is an acute pathological state and it is often difficult to make a definite diagnosis in the early stage. It is mostly identified during emergency surgery. We present a case of gallbladder torsion with typical imaging features, such as V-shaped distortion of the extrahepatic bile ducts, and twisting signs on magnetic resonance cholangiopancreatography, from which we were able to make an early diagnosis. Early confirmation of this emergency will enable prompt surgery with good prognosis.
