An 81-year-old female patient presented to the surgical emergency department with acute upper abdominal pain as well as nausea and vomiting. Examination of the abdomen revealed pain on palpation in the upper right abdomen with local abdominal guarding. Laboratory results showed a discreet infection constellation (leukocytes 12.1/nL, creatinine levels were normal). Ultrasound and computed tomography imaging demonstrated gallbladder hydrops with extension of the gallbladder in a caudal direction to the level of the pelvic inlet (Figure a, asterisk) with surrounding fluid and focal peritoneal enhancement (Figure a, arrow). In view of the acute cholecystitis with gallbladder hydrops, open cholecystectomy was indicated in this patient with a history of cardiac disease. Intraoperatively, the rare picture of gallbladder volvulus (> 180°) with hemorrhagic gangrenous cholecystitis due to a “free-hanging” gallbladder was seen, that is to say, the gallbladder was not attached to the liver Figure b. This clinical picture occurs with an incidence of 1/350 000, often affecting women in the 7th decade of life (ratio F:M, 5:1). Following detorsion of the gallbladder, cholecystectomy was performed. The patient was discharged free of symptoms on postoperative day 4.
Figure.
a) Computed tomography of the abdomen (portal venous phase, coronal reconstruction with a slice thickness of 18 mm), arrow: perivesical fluid and edema of the gallbladder wall, asterisk: gallbladder hydrops to the level of the iliac crest
b) Intraoperative finding of > 180° gallbladder volvulus
Translated from the original German by Christine Rye.
Cite this as: Baumgart J, Stroh K, Lang H: Acute hemorrhagic cholecystitis due to gallbladder volvulus.
Footnotes
Conflict of interest statement:
The authors declare that no conflict of interest exists.