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Case report
Torsion of the gallbladder: a rare but important differential to consider when treating acute cholecystitis non-operatively
  1. Arun Ahluwalia1,
  2. Matthew George Roy Allaway2,
  3. Serena Giga1 and
  4. Richard James Curran2
  1. 1Blacktown Hospital, Blacktown, New South Wales, Australia
  2. 2Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
  1. Correspondence to Dr Arun Ahluwalia; arun.ahluwalia{at}health.nsw.gov.au

Abstract

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.

  • pancreas and biliary tract
  • biliary intervention
  • general surgery

https://doi.org/10.1136/bcr-2020-237842

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    Footnotes

    • Contributors AA is the guarantor for the completed case report. He involved in planning the case report, literature search, writing of the report and editing the report. He involved in obtaining patient consent. MGRA was involved in writing and planning the case report, literature search and editing the case report. He was involved with in hospital management of the case. SG was involved with writing, editing the case report and the literature search. RJC was involved with writing and editing the case report. He was directly involved with the in hospital management of the case including the patients operation and peri-operative treatment.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.