CASE REPORT:
A26 year-old man with no medical or surgical or drug history was
admitted to our Surgical department for cramped abdominal pain in the
right hypochondrium associated with vomiting. This pain had been present
for 24 hours and was of increasing intensity. There was no fever neither
jaundice. Vital parameters were normal. The abdominal exam showed
tenderness in the right upper quadrant. Laboratory tests showed white
blood cells at 14470/mm3, a C-reactive protein at 3 mg/L, with no
alteration of the liver; and pancreatic tests.
Ultrasound was initially performed, demonstrating double-wall thickening
of the gallbladder with no distention associated nor gallstones (figure
1). CT scan was performed confirming gallbladder diffuse wall
thickening, an abrupt tapering of the cystic duct and cystic artery
(figure 2). A preoperative diagnosis of gallbladder torsion was
suspected, so the decision was taken to perform an exploratory
laparoscopy. Intra-operatively the gall bladder was gangrenous, was
hanging freely and a torsion around the gallbladder axis less than 180°
was noted in the peritoneum cavity and was attached only along the gall
bladder neck (figure 3), detorsion was done manually by flange section,
and cholecystectomy was carried out (figure4). the post-operative
recovery occurred without incidents.