Torsion of the gallbladder. A review of four cases.

Four cases of torsion of the gallbladder have been gathered from this area. Three were admitted to our local hospitals and the fourth case occurred in the Veteran's Hospital in Fayetteville. The average age of these four cases was 85, and all patients were very thin. Three patients were female and one was male. One patient died following surgery. This patient had sought help rather late, and died of cardiopulmonary complications. This entity is rare, and only scattered cases are found in the literature. Biliary calculi are found in approximately 50% of the cases. The exact etiology of the torsion is unknown. A redundant mesentery is always present, and kyphosis is frequent. Our patients were all thin. Botha has postulated that vigorous peristalsis in the neighboring viscera or sudden body movement may be responsible. The diagnosis is rarely made preoperatively, but if surgery is not done, death will probably ensue. Later reports have indicated that sonography and abdominal CT scanning might prove helpful in establishing a diagnosis.