胆嚢捻転症の2例

Torsion of the gallbladder is a rare entity and pre-operative diagnosis of the disease is uncommon. Since it was first described by A.V. Wendel in 1898, about 400 cases have been reported in the literature. Two cases of torsion of the gallbladder were presented. First case was 82 year old male who was admitted with 48 hour history of right upper quadrant abdominal pain, fever, and vomiting. On physical examination there was right upper quadrant tenderness with muscle guarding and rebound tenderness. An abdominal ultrasonogram and CT showed a distended gallbladder with thickness of the wall and a stone. A diagnosis of cholecystitis due to the stone was made and conservative therapy was tried. But the condition didn’t become better and a cholecystectomy was performed 2days later. The gallbladder was found to be necrotic with a 360 degree in an anticlock wise direction. Post operative recovery was unremarkable and the patient discharged at 12 days. Second case was 80 year old female who was admitted with 11 hour history of right upper quadrant abdominal pain and vomiting. A physical examination was similar to the first case. An abdominal ultrasonogram showed a distended and floating gallbladder. A diagnosis of torsion of the gallbladder was made without CT and a cholecystectomy was performed immediately. The gallbladder was found to be necrotic with a 360 degree in an anticlock wise direction. Post operative recovery was unremarkable and the patient discharged at 16 days.