Laparoscopic management of a two staged gall bladder torsion

Figure 1 Axial section showing peripherally enhancing fluid density area seen along the segment 5 and 6 of the liver.

Figure 2 Coronal section showing peripherally enhancing fluid density area seen along the segment 6 of the liver. The gall bladder is not seen in the gall bladder fossa.

Figure 3 Laparoscopic view showing distorted anatomy. A: Adhesions between the gall bladder and the lateral abdominal wall; B: Pulled in peritoneal fold from the pylorus of the stomach and the hepatic flexure.

Figure 4 Zoomed in view of Calot’s region. B: Pulled in peritoneal fold from the pylorus of the stomach and the hepatic flexure.

Figure 5 Adhesions between the gall bladder and the lateral abdominal wall.

Figure 6 Rotated Riedel’s lobe. A: Gangrenous fundus of the gall bladder; B: Pulled in peritoneal fold from the pylorus of the stomach and the hepatic flexure.

Figure 7 Gangrenous gall bladder after adhesiolysis. A: Adhesive band between the neck of the gall bladder and the Riedel’s lobe.

Figure 8 Gall bladder found gangrenous till its neck.

Figure 9 After derotation, the gall bladder in its normal position with the long and twisted cystic artery (A) and cystic duct (D).