Acute gallbladder torsion: an unexpected intraoperative finding

We report a case of acute gallbladder torsion in an elderly lady and review the clinical aspect of the disease.Gallbladder torsion is an uncommon clinical entity and a difficult condition to diagnose preoperatively. It is known to occur when there is rotation of the gallbladder along the axis of the cystic duct and vascular pedicle. Since its first description in 1898 by Wendel, there have been over 500 documented cases in the literature [1,2]. Except for isolated cases reported in childhood, this disease is more frequently encountered in the elderly with 85% of the cases reported between the ages of 60 and 80 years [2-5]. There is a female preponderance with a female to male ratio of 3:1 [2-5].The common causative factor is an abnormality in the anatomy of the gallbladder and its associated vascular pedicle. In general, this is mainly due to the two mesenteric anatomical variations including either a wide or a long mesentery with cystic artery and duct. This is referred to as a 'floating' or 'pedunculated' gallbladder [2,3,5-7]. In the elderly, loss of viscera fat with liver atrophy can result in acquired long mesentery [7]. Gallbladder torsion typically presents as acute abdomen requiring emergency surgery but preoperative diagnosis of gallbladder torsion is difficult and most cases are found as a surprise at surgery.We report a case of acute gallbladder torsion in an elderly lady and review the clinical aspects of the disease.A 79 year old lady presented to Accident & Emergency department with a two day history of sudden onset colicky abdominal pain associated with vomiting and progressive abdominal distension. She had failed to pass any faeces or flatus 24 hours prior to presentation. She denied any history of recent change in bowel habit or weight loss. There was no significant relevant past medical history.She was dehydrated at presentation with the following vital signs: HR-107 b/min, BP-119/50 mmHg, T-36.5°C, oxygen saturation-97% on air. Abdomen was distend