Published online Jun 26, 2020. doi: 10.12998/wjcc.v8.i12.2667
Peer-review started: February 22, 2020
First decision: May 1, 2020
Revised: May 9, 2020
Accepted: May 27, 2020
Article in press: May 27, 2020
Published online: June 26, 2020
Gallbladder torsion is a rare acute abdominal condition that requires emergency surgery. It occurs more commonly in elderly people and in women in the adult population. Diagnosis is a challenge as non-specific symptoms and signs have been reported on ultrasonography, computed tomography and magnetic resonance imaging. Prompt cholecystectomy can decrease the mortality and morbidity of perforation due to gallbladder torsion.
An 82-year-old woman with upper-right quadrant pain and associated nausea and vomiting was diagnosed with ectopic acute calculus cholecystitis. Magnetic resonance cholangiopancreatography (MRCP) showed a V-shaped distortion of the extrahepatic bile ducts and a particularly extended twisted cystic duct, which indicated the presence of gallbladder torsion. Emergency laparoscopic cholecystectomy confirmed the diagnosis and the patient recovered without incident.
Gallbladder torsion can be diagnosed pre-operatively by MRCP. The specific signs are a V-shaped distortion of the extrahepatic bile ducts and a particularly extended twisted cystic duct which can be called twisting signs.
Core tip: Gallbladder torsion is an acute pathological state and it is often difficult to make a definite diagnosis in the early stage. It is mostly identified during emergency surgery. We present a case of gallbladder torsion with typical imaging features, such as V-shaped distortion of the extrahepatic bile ducts, and twisting signs on magnetic resonance cholangiopancreatography, from which we were able to make an early diagnosis. Early confirmation of this emergency will enable prompt surgery with good prognosis.