Published online Dec 27, 2015. doi: 10.4240/wjgs.v7.i12.403
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
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.
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.