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05 October 2019 : Case report  Lebanon

A Rare Presentation of Gall Bladder Volvulus: A Case Report

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare disease

Antoine Kachi12BCDEF, Gregory Nicolas3BCDE*, Jason Nasser4BCDEF, Mohamad Hashem1BCE, Chahine Abou Sleiman5BCEF

DOI: 10.12659/AJCR.916234

Am J Case Rep 2019; 20:1466-1470

Abstract

BACKGROUND: Gall bladder volvulus is a rare clinical entity, with only around 500 cases reported in the literature. It is defined as the rotation of the gallbladder on its mesentery along the axis of the cystic pedicle, although cases of torsion of the gallbladder fundus itself have been reported.

CASE REPORT: A 78-year-old woman presented for severe right upper-quadrant abdominal pain that began acutely 3 days prior. Her pain was accompanied by nausea and vomiting. She also reported feeling chills. Abdominal X-ray revealed a 7-cm-diameter subhepatic opacity containing gas. Abdominal ultrasound and CT scan revealed a distended and displaced gallbladder located below the liver, in contact with the right kidney. Subsequently, open cholecystectomy was performed, and a distended, necrotic gallbladder was found twisted on its pedicle; thus, a gall bladder volvulus was diagnosed.

CONCLUSIONS: In our patient, the classic patient characteristics of an elderly thin female with kyphosis were present. However, the rest of the presentation was not typical of gallbladder volvulus due to the patient’s delay in seeking treatment, and was representative of the necrotic phase of gallbladder torsion, in which the patient becomes ill-appearing, with fever and chills, with significant abdominal rigidity.

Keywords: Abdominal Pain, Cholecystectomy, Cholecystitis, Acute, Aged, Gallbladder, gallbladder diseases, Nausea, Necrosis, Radiography, Torsion Abnormality, Ultrasonography, Vomiting

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923