Medicine · 2025
Two cases of gallbladder torsion presenting with right lower quadrant pain: Clinical and imaging characteristics.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Liu Xue-Wu, Liang Jun-Qiang, Wu Yuan-Yuan, Lei Nan
Аннотация
RATIONALE: Gallbladder torsion (GT) is a rare cause of acute abdominal pain. Due to its rarity and nonspecific clinical presentation, GT is frequently misdiagnosed preoperatively. We report 2 cases of GT in patients initially suspected of acute appendicitis, both presenting with right lower abdominal pain. We conducted a retrospective analysis of the clinical and radiological findings in these 2 patients to enhance our understanding of and management for this condition.
PATIENT CONCERNS: Case 1 was a thin 80-year-old woman who was admitted to the hospital with migration of pain to the right lower quadrant, persisting for 3 days. Case 2 was a thin 84-year-old woman who was admitted to the hospital with right-sided abdominal pain that had persisted for over 20 hours.
DIAGNOSES: Emergency abdominal ultrasound examination revealed a low-lying gallbladder in case 2 and an enlarged gallbladder with a small amount of perigallbladder fluid collection in both patients. Non-contrast computed tomography revealed an enlarged gallbladder with disrupted gallbladder mucosa in both cases. In addition, the first case exhibited a whirlpool structure in the cystic duct region, alongside a pedicled hyperdense structure located between the neck of the gallbladder and the liver bed. In the second case, a strip-like structure was observed within the cystic duct area. Postoperative pathology confirmed acute gangrenous cholecystitis in both patients' gallbladders and acute simple appendicitis in their appendices.
INTERVENTIONS: Both patients underwent laparoscopic cholecystectomy.
OUTCOMES: Both patients recovered well and were discharged within 1 week.
LESSONS: GT presenting with appendicitis-like symptoms is relatively uncommon. For thin elderly female patients presenting with signs related to appendicitis, the possibility of GT should be considered. Non-contrast computed tomography is valuable for diagnosing GT.
PATIENT CONCERNS: Case 1 was a thin 80-year-old woman who was admitted to the hospital with migration of pain to the right lower quadrant, persisting for 3 days. Case 2 was a thin 84-year-old woman who was admitted to the hospital with right-sided abdominal pain that had persisted for over 20 hours.
DIAGNOSES: Emergency abdominal ultrasound examination revealed a low-lying gallbladder in case 2 and an enlarged gallbladder with a small amount of perigallbladder fluid collection in both patients. Non-contrast computed tomography revealed an enlarged gallbladder with disrupted gallbladder mucosa in both cases. In addition, the first case exhibited a whirlpool structure in the cystic duct region, alongside a pedicled hyperdense structure located between the neck of the gallbladder and the liver bed. In the second case, a strip-like structure was observed within the cystic duct area. Postoperative pathology confirmed acute gangrenous cholecystitis in both patients' gallbladders and acute simple appendicitis in their appendices.
INTERVENTIONS: Both patients underwent laparoscopic cholecystectomy.
OUTCOMES: Both patients recovered well and were discharged within 1 week.
LESSONS: GT presenting with appendicitis-like symptoms is relatively uncommon. For thin elderly female patients presenting with signs related to appendicitis, the possibility of GT should be considered. Non-contrast computed tomography is valuable for diagnosing GT.