Academic Journals Database
Disseminating quality controlled scientific knowledge

Acute gallbladder torsion - a continued pre-operative diagnostic dilemma

Author(s): Mouawad Nicolas | Crofts Brianne | Streu Rachel | Desrochers Randal | Kimball Beth

Journal: World Journal of Emergency Surgery
ISSN 1749-7922

Volume: 6;
Issue: 1;
Start page: 13;
Date: 2011;
Original page

Abstract Acute gallbladder volvulus continues to remain a relatively uncommon process, manifesting itself usually during exploration for an acute surgical abdomen with a presumptive diagnosis of acute cholecystitis. The pathophysiology is that of mechanical organo-axial torsion along the gallbladder's longitudinal axis involving the cystic duct and cystic artery, and with a pre-requisite of local mesenteric redundancy. The demographic tendency is septua- and octo-genarians of the female sex, and its overall incidence is increasing, this being attributed to increasing life expectancy. We discuss two cases of elderly, fragile women presenting to the emergency department complaining of sudden onset right upper quadrant abdominal pain. Their subsequent evaluation suggested acute cholecystitis. Ultimately both were taken to the operating room where the correct diagnosis of gallbladder torsion was made. Pre-operative diagnosis continues to be a major challenge with only 4 cases reported in the literature diagnosed with pre-operative imaging; the remainder were found intra-operatively. Consequently, a delay in diagnosis can have devastating patient outcomes. Herein we propose a necessary high index of suspicion for gallbladder volvulus in the outlined patient demographic with symptoms and signs mimicking acute cholecystitis.

Tango Rapperswil
Tango Rapperswil

RPA Switzerland

Robotic Process Automation Switzerland