Laparoscopic management of a two staged gall bladder torsion

作     者：Yadav Kamal Sunder Sali Priyanka Akhilesh Garg Raman Sharma Deborshi Mehta Hitesh Shantilal 

作者机构：G.I.Surgery DepartmentLilavati Hospital and Research Centre General Surgery DepartmentLady Hardinge Medical College 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2015年第7卷第12期

页      面：403-407页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：Supported by Lilavati Hospital and Research Centre 

主　　题：Gall bladder torsion Gangrenous gallbladder Perforated gall bladder Two staged torsion ofthe gall bladder Laparoscopic cholecystectomy 

摘      要：Gall bladder torsion(GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel s lobe(part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful postoperative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot s triangle. Laparoscopic cholecystectomy has the benefit of early recovery.