Acute abdominal pain and nausea. Laboratory investigation showed a mild inflammatory syndrome.
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A CT scan shows a large gallbladder extending into the right lower abdomen. The gallbladder wall is fairly enhanced.
Ultrasound was performed but demonstrated no gallstones. The diagnosis of acalculous cholecystitis was made, however, laparoscopy demonstrated gallbladder torsion with necrotic wall and a cholecystectomy was performed.
Gallbladder torsion is a very rare cause of acute abdomen. It is mainly seen in elderly women and occurs in patients with an anatomic variation of gallbladder fixation to the liver. Symptoms of gallbladder torsion are nonspecific and include acute onset of abdominal pain, nausea, and vomiting.
The absence of bile stones in a gallbladder with signs of cholecystitis can suggest a torsion of the gallbladder. Besides an abnormal location of the gallbladder, a swirl sign of the cystic duct can be seen on CT images. The gallbladder will be more distended in torsion than in a normal acute cholecystitis. Treatment of a tordated gallbladder is emergency cholecystectomy.