Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.14068
Revised: May 7, 2014
Accepted: June 13, 2014
Published online: October 14, 2014
Gallbladder torsion is a rare, acute abdominal disease. It was first reported by Wendell in 1898. Since then, only 500 cases have been reported. Gallbladder torsion occurs in all age groups, although it usually appears in the latter stages of life. The occurrence ratio between women and men is 3:1. Most cases are diagnosed during surgery. The main treatment is surgical detorsion and cholecystectomy. Despite progress in radiologic imaging diagnosis, it is not easy to obtain a precise preoperative diagnosis of gallbladder torsion. In previous reports, only 9.8% of all gallbladder torsion cases were diagnosed preoperatively. We present a case of acute body-neck gallbladder torsion in an elderly man, and we review the radiologic findings of magnetic resonance imaging, computed tomography, and ultrasonography. The radiologic findings in the present case were helpful in obtaining a preoperative diagnosis of gallbladder torsion. The diagnosis was confirmed by T2-weighted magnetic resonance images, which showed an intra-gallbladder segment located between the body and neck of the gallbladder, with a notable crease within this segment.
Core tip: Torsion of the gallbladder is a rare condition and is very difficult to diagnose preoperatively, despite advances in diagnostic imaging. This diagnosis should be considered in all elderly patients presenting with acute or non-resolving symptoms and signs suggestive of cholecystitis, particularly in the absence of gallstones. Early diagnostic imaging and prompt cholecystectomy are crucial. In this case of gross type 1 floating gallbladder, T2-weighted magnetic resonance imaging showed an intra-gallbladder segment located between the body and neck of the gallbladder. Magnetic resonance cholangiopancreatography indicated V-shaped distortion of the extrahepatic bile duct and a tapered cyst duct.