Koyanagi Takahiro, Sato Kaoru
Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi Pref,, 329-0431, Japan.
J Med Case Rep. 2012 Sep 11;6:289. doi: 10.1186/1752-1947-6-289.
Torsion of the gallbladder is an extremely rare cause of acute abdomen, which commonly affects thin elderly women. A prompt surgical approach is necessary to avoid fatal complications associated with gangrene and perforation of the gallbladder. However, it is difficult to make a preoperative diagnosis using ordinary imaging modalities.
An 84-year-old Japanese woman was admitted to our hospital due to left lower abdominal pain. Her pain shifted suddenly to the right upper abdomen a half day after admission. Although her enlarged and wall-thickened gallbladder had been already seen at admission, it rotated approximately 180 degrees and deviated to the midline of her abdomen on the second computed tomography scan, which helped us to make a correct diagnosis of gallbladder torsion. The patient underwent an emergency operation (detorsion and cholecystectomy) and recovered without any complications. The gallbladder had necrosis due to torsion.
Sequential diagnostic imaging might be helpful to make a preoperative diagnosis of gallbladder torsion when the gallbladder is enlarged and wall thickened but the patient does not present with typical clinical symptoms.
胆囊扭转是急性腹痛的一种极其罕见的病因，常见于消瘦的老年女性。为避免与胆囊坏疽和穿孔相关的致命并发症，必须迅速采取手术治疗。然而，使用普通成像方式进行术前诊断很困难。
一名84岁的日本女性因左下腹疼痛入院。入院半天后，她的疼痛突然转移至右上腹。尽管入院时已发现其胆囊增大且壁增厚，但在第二次计算机断层扫描时，胆囊旋转了约180度并偏向腹部中线，这有助于我们正确诊断胆囊扭转。患者接受了急诊手术（扭转复位和胆囊切除术），术后恢复良好，无任何并发症。胆囊因扭转出现坏死。
当胆囊增大且壁增厚但患者未表现出典型临床症状时，序贯诊断成像可能有助于胆囊扭转的术前诊断。
