Wu Tianchong, Huang Wenhao, He Baochun, Guo Yuehua, Peng Gongzhe, Li Mingyue, Bao Shiyun
Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China.
Ann Transl Med. 2022 May;10(10):616. doi: 10.21037/atm-22-1425.
Gallbladder torsion is very rare and easily misdiagnosed as biliary disease. It is defined as the rotation of the gallbladder along the axis of the cystic pedicle on the mesentery. As gallbladder rotation involves the gallbladder artery, the blood supply is blocked, resulting in gallbladder ischemia and eventual necrosis. If misdiagnosis occurs and treatment is delayed, gallbladder torsion can develop into a lethal disease. The typical imaging features of gallbladder torsion in this case are a good learning resource for our young physicians, as well as providing a rare, unusual and typical case for our current literature database.
We present a rare case of gallbladder torsion in a 19-year-old man. The patient complained of sudden recurrent pain and discomfort in the right upper abdomen with vomiting for 12 hours. Abdominal ultrasound and computed tomography (CT) scan showed gallbladder enlargement and signs of acute cholecystitis in emergency examination, and there were no signs of cholecystolithiasis. Considering that the patient was a young male and the patients prefer conservative treatment, symptomatic treatment was given. However, there was no obvious effect after 1 day of medical treatment, but severe abdominal pain in the upper right quadrant continues to progress. Finally, the patient underwent laparoscopic cholecystectomy, and the gallbladder was found to be enlarged with ischemic necrosis, which was caused by gallbladder torsion. The patient recovered 2 days after surgery and was discharged without complications.
Although the clinical manifestation is similar to that of typical acute calculous cholecystitis, gallbladder torsion can be diagnosed early through some special signs on imaging examination, such as distorted cystic duct signs ("beak and whirl" sign), gallbladder dilatation with gallbladder fossa effusion, and gallbladder in the horizontal position. These signs can help primary surgical treatment and prevent fatal complications such as gallbladder gangrene, perforation, and biliary peritonitis. Therefore, for inexperienced doctors, careful imaging features are required for the correct diagnosis of rare gallbladder torsion.
Gallbladder torsion; acute abdominal disease; cholecystitis; case report.
胆囊扭转非常罕见，很容易被误诊为胆道疾病。它被定义为胆囊沿肠系膜上胆囊蒂的轴线发生旋转。由于胆囊旋转涉及胆囊动脉，血液供应受阻，导致胆囊缺血并最终坏死。如果发生误诊且治疗延迟，胆囊扭转可发展为致命疾病。该病例中胆囊扭转的典型影像特征对年轻医生来说是很好的学习资源，同时也为我们当前的文献数据库提供了一个罕见、不寻常且典型的病例。
我们报告一例19岁男性的罕见胆囊扭转病例。患者主诉右上腹突发反复疼痛、不适并伴有呕吐12小时。急诊腹部超声和计算机断层扫描（CT）显示胆囊增大及急性胆囊炎征象，且无胆囊结石迹象。考虑到患者为年轻男性且患者倾向保守治疗，给予了对症治疗。然而，治疗1天后无明显效果，右上腹剧痛持续进展。最终，患者接受了腹腔镜胆囊切除术，术中发现胆囊增大并伴有缺血坏死，系胆囊扭转所致。患者术后2天康复出院，无并发症。
尽管临床表现与典型急性结石性胆囊炎相似，但通过影像检查的一些特殊征象，如扭曲的胆囊管征象（“喙和漩涡”征）、胆囊扩张伴胆囊窝积液以及胆囊处于水平位等，可早期诊断胆囊扭转。这些征象有助于进行一期手术治疗，预防胆囊坏疽、穿孔及胆汁性腹膜炎等致命并发症。因此，对于经验不足的医生而言，仔细观察影像特征对于正确诊断罕见的胆囊扭转至关重要。
胆囊扭转；急腹症；胆囊炎；病例报告
