Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2015; 7(12): 403-407
Published online Dec 27, 2015. doi: 10.4240/wjgs.v7.i12.403
Laparoscopic management of a two staged gall bladder torsion
Yadav Kamal Sunder, Sali Priyanka Akhilesh, Garg Raman, Sharma Deborshi, Mehta Hitesh Shantilal
Yadav Kamal Sunder, Sali Priyanka Akhilesh, Garg Raman, Mehta Hitesh Shantilal, G.I. Surgery Department, Lilavati Hospital and Research Centre, Mumbai, Maharashtra 400050, India
Sharma Deborshi, General Surgery Department, Lady Hardinge Medical College, New Delhi, Delhi 110001, India
Author contributions: Sunder YK and Akhilesh SP contributed equally to this work; Sunder YK, Akhilesh SP and Raman G designed the research; Sunder YK, Akhilesh SP and Shantilal MH performed the research; Deborshi S analyzed the data; and Akhilesh SP wrote the paper.
Supported by Lilavati Hospital and Research Centre.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at Lilavati Hospital and Research Centre.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yadav Kamal Sunder, MS, G.I. Surgery Department, Lilavati Hospital and Research Centre, A-791, Bandra Reclamation, Bandra West, Mumbai, Maharashtra 400050, India. dockamalyadav@gmail.com
Telephone: +91-99-20375758 Fax: +91-22-26407655
Received: June 29, 2015
Peer-review started: July 12, 2015
First decision: August 14, 2015
Revised: August 21, 2015
Accepted: September 25, 2015
Article in press: September 28, 2015
Published online: December 27, 2015
Abstract

Gall bladder torsion (GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel’s lobe (part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful post-operative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot’s triangle. Laparoscopic cholecystectomy has the benefit of early recovery.

Keywords: Gall bladder torsion, Gangrenous gall bladder, Perforated gall bladder, Two staged torsion of the gall bladder, Laparoscopic cholecystectomy

Core tip: Gall bladder torsion is a rare surgical entity that should be considered in a case of suspicious acute cholecystitis not responding to conservative management. Delay in diagnosis and treatment may lead to gall bladder gangrene, gall bladder perforation, biliary peritonitis or septicaemia. The condition is seldom recognized preoperatively due to its clinical resemblance to acute cholecystitis. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found to have a two staged torsion of the gall bladder with twisting of the Riedel’s lobe. This dual entity has so far not been reported in literature.