Gallbladder torsion - clinical picture, diagnosis, treatment

Gallbladder torsion (GB) is a rare surgical emergency condition. It is potentially life-threatening event if the diagnosis is established late because of its insidious course and the gravity of the clinical presentation. The most often patients are elderly, in their seventh or eight decades of life, predominately women (in 85% of cases and a 3:1 female predominance). The etiology is unknown, but a constant finding is the presence of the GB on a mobile mesentery (floating gallbladder) and loss of visceral fat. The organ twists along the axis of the cystic duct and cystic artery what results with occlusion of bile and blood flow. According to the degree of rotation symptoms, and signs may vary. Patients are usually presented with a sudden, acute pain in the right upper quadrant. Peritoneal irritation signs are present. Abdominal ultrasonography show swollen hydropic GB often with multiple stones in it. Emergency laparotomy show remarkable necrosis or GB gangrene. Any delay in treatment can be fatal as the GB may rupture, leading to biliary peritonitis. The mandatory treatment for this condition is surgical detorsion and cholecystectomy.