Amarillo H A, Pirchi E D, Mihura M E
General Surgical Service, Buenos Aires British Hospital, 74 Perdriel Street, Buenos Aires, C1280AEB, Argentina.
Surg Endosc. 2003 May;17(5):832-3. doi: 10.1007/s00464-002-4528-3.
Complete gallbladder torsion is an unusual emergency that requires immediate surgical treatment. Since it was first reported in 1898, <400 cases have been described in the literature, and only three of them were diagnosed and treated by laparoscopic cholecystectomy. Our objective here is to describe an approach that allows a definitive diagnosis and treatment. First we present the case of a febrile 81-year-old woman with acute right upper quadrant pain. Ultrasound showed an alithiasic distended gallbladder with a multilayered wall and a transverse orientation. When exploratory laparoscopy was performed, a gangrenous gallbladder secondary to a 360 degrees clockwise cystic pedicle torsion was found. Laparoscopic decompression, detorsion, and cholecystectomy with an intraoperative cholangiogram were completed. The patient was discharged 72 h later. Next, several preoperative diagnostic methods are reviewed. We conclude that the laparoscopic treatment of this entity is feasible and obviates the performance of unnecessary and nonspecific tests. It offers a favorable and rapid postoperative recovery, in addition to the other well-known advantages of the minimally invasive surgical approach.
完全性胆囊扭转是一种罕见的急症，需要立即进行手术治疗。自1898年首次报道以来，文献中描述的病例不足400例，其中仅有3例通过腹腔镜胆囊切除术进行诊断和治疗。我们在此的目的是描述一种能够进行明确诊断和治疗的方法。首先，我们介绍一例81岁发热女性，伴有急性右上腹疼痛。超声检查显示胆囊无结石、扩张，胆囊壁呈多层，且胆囊呈横向位。在进行探查性腹腔镜检查时，发现胆囊坏疽是由胆囊蒂顺时针扭转360度所致。完成了腹腔镜减压、扭转复位及胆囊切除术，并进行了术中胆管造影。患者在72小时后出院。接下来，回顾了几种术前诊断方法。我们得出结论，腹腔镜治疗该疾病是可行的，可避免进行不必要的非特异性检查。除了微创外科手术方法的其他众所周知的优点外，它还能使患者术后恢复良好且迅速。
