- 期刊
Acute Cholecystitis due to Torsion of Gallbladder Neck: A Case Report
膽囊扭轉造成之急性膽囊炎：病例報告
摘要
Gallbladder torsion is a rare but life-threatening emergency. Complete torsion may rapidly progress to gangrene, perforation, and death. Therefore, prompt surgical management is important. However, the diagnosis is challenging because gallbladder torsion present the signs and symptoms as cholecystitis. This condition is often identified intraoperatively. We described a 76-year-old woman presented with sudden-onset, severe abdominal pain. On physical examination, she was afebrile with marked tenderness in the right upper quadrant. Laboratory data showed normal white cell count and biochemistry. Computerized tomography demonstrated calculus of the gallbladder with thickened wall and dilatation of the biliary tracts. She was admitted under impression with acute calculous cholecystitis and was treated conservatively. Due to exacerbation of pain, we arranged emergent operation on the third day. Intra-operatively, the gallbladder was found 360 ◦ counterclockwise torsion along the cystic pedicle resulting in gangrenous change. After unraveling clockwise, chole-cystectomy was performed smoothly. The postoperative course was uneventful, and she was discharged smoothly 14 days after operation.
並列摘要
膽囊扭轉係一罕見但致命的急症，完全扭轉將快速地進展至壞死、穿孔甚至死亡。因此適時的手術介入是相當重要的。然而要正確診斷出膽囊扭轉卻不容易，因為其症狀常與膽囊炎混淆，以致大部分的扭轉都是術中才發現。我們報導一76歲女性，來診主訴為急性腹痛。理學檢查顯示沒有發燒、右上腹明顯壓痛。抽血檢驗之白血球及其他生化數值均為正常。電腦斷層指出有膽囊結石、囊壁增厚並有膽道擴張。經初步診斷為膽結石合併急性膽囊炎入院接受保守藥物治療。但住院後第三天，因腹痛加劇，安排緊急手術。術中發現膽囊沿其軸體逆時針扭轉360度以致壞死。經順時針復位後，順利實施膽囊切除。術後病人恢復良好，出院後亦無併發症產生。