Two cases of torsion of the gallbladder diagnosed preoperatively

Background:The authors experienced two cases of torsion of the gallbladder, both of which were correctly diagnosed preoperatively. Methods: Two boys, aged 4 and 5 years, were transferred to Yokohama City Seibu Hospital because of their acute abdominal disorders. Diagnostic imaging demonstrated acute inflammatory changes in the gallbladder with an abnormal arrangement of the gallbladder and common bile duct in both cases. Laparotomy findings showed torsion of the gallbladder by 180 degrees and 360 degrees, respectively, at the cystic ducts, resulting in gangrenous change. Results: Both children recovered uneventfully after cholecystectomy. The diagnostic imaging criteria are (1)collection of fluid between the gallbladder and the gallbladder fossa of the liver, (2) a horizontal rather than vertical arrangement of the long axis of the gallbladder, (3) the presence of a well enhanced cystic duct located on the right side of the gallbladder, and (4) signs of inflammation including marked edema with thickening of the wall. Conclusions: The authors report the clinical characteristics of this uncommon condition, and discuss the significance of accurate preoperative diagnosis of these acute surgical disorders. Copyright (C) 1997 by W.B. Saunders Company.