PMC6349984_01
Computed tomography image demonstrating significant acute cholecystitis, associated with a dilated and thickened wall gallbladder plus pericholecystic free fluid and fat stranding.
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C-reactive protein (CRP) 2 mg/L, white cell count (WCC) 11 x 109/L and lipase 18 U/L. Computed tomography (CT) imaging revealed significant acute cholecystitis, associated with a moderately dilated gallbladder (4.5 cm diameter), thickened gallbladder wall, pericholecystic free fluid and fat stranding (Figure 1).
Intraoperative photo demonstrating gallbladder (GB) torsion and associated GB necrosis. Note position of GB situated upon the diaphragmatic hepatic surface instead of within the GB fossa. Also note the thin and suspended GB pedicle which contained both the cystic duct and artery, and which was the axis of torsion, thus producing resultant GB ischaemia.
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Operative findings were of a pedicled, suprahepatic gallbladder on a narrow cystic duct stalk which appeared acutely torted with consequent complete gallbladder necrosis and perforation (Figure 2).