A Case of Torsion of Gallbladder Treated Laparoscopically, Immediately after Onset from Radiological Imaging

Takaho Okada, Yasusuke Murakami, Koji Itoh, Yu Katayose* and Ryuji Sato

Department of Gastroenterological Surgery, Sendai Kosei Hospital
Division of Gastroenterological Surgery, Tohoku University Graduate School of Medical Science*

A 91-year-old man admitted for progressive upper right quadrant pain and vomiting, and tenderness without muscular defense of the right hypochondrium was found in laboratory test to have marked inflammation and slight jaundice. CT showed swelling and wall-thickening of the entire gallbladder, but it was not enhanced. Characteristic low-density phyma was confirmed in the cervix. Suspecting necrotizing cholecystitis caused by gallbladder torsion, we immediately undertook laparoscopic cholecystectomy (LC). The Gross type-I floating gallbladder was twisted clockwise 360 degrees at the axis in the cystic duct (CD). Dilation of the common bile duct (CBD) and choledocholithiasis were observed in intraoperative cholangiography. As general condition of the patient got worse, we only inserted c-tube into the CBD. Histopathological findings showed acute bleeding infarction of the gallbladder followed by torsion in the CD. Severe inflammation was negligible in the gallbladder cervix, and LC is regarded as the most useful way to treat this condition.

Key words
gallbladder torsion, laparoscopic cholecystectomy

Reprint requests
Takaho Okada Department of Gastroenterological Surgery, Sendai Kosei Hospital
4-15 Hirose-machi, Aoba-ku, Sendai 980-0873 JAPAN

Accepted
November 26, 2003

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