CASE REPORT:
A26 year-old man with no medical or surgical or drug history was admitted to our Surgical department for cramped abdominal pain in the right hypochondrium associated with vomiting. This pain had been present for 24 hours and was of increasing intensity. There was no fever neither jaundice. Vital parameters were normal. The abdominal exam showed tenderness in the right upper quadrant. Laboratory tests showed white blood cells at 14470/mm3, a C-reactive protein at 3 mg/L, with no alteration of the liver; and pancreatic tests.
Ultrasound was initially performed, demonstrating double-wall thickening of the gallbladder with no distention associated nor gallstones (figure 1). CT scan was performed confirming gallbladder diffuse wall thickening, an abrupt tapering of the cystic duct and cystic artery (figure 2). A preoperative diagnosis of gallbladder torsion was suspected, so the decision was taken to perform an exploratory laparoscopy. Intra-operatively the gall bladder was gangrenous, was hanging freely and a torsion around the gallbladder axis less than 180° was noted in the peritoneum cavity and was attached only along the gall bladder neck (figure 3), detorsion was done manually by flange section, and cholecystectomy was carried out (figure4). the post-operative recovery occurred without incidents.