PMC5517785_01
Findings of abdominal ultrasonography (US).. US images showing a swollen gallbladder (a) and reduced blood flow to the gallbladder (b).
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Abdominal ultrasonography (US) showed a swollen gallbladder with scarce blood flow in the wall (Fig. 1a and b).
Findings of abdominal contrast enhanced computed tomography (CT).. (a) CT image showing a swollen gallbladder and poorly enhanced mucous membrane.. (b) The gallbladder wall is thick and the fundus gallbladder is displaced below the midline.
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The gallbladder wall was thick and the fundus was displaced toward the center of the abdomen (Fig. 2a and b).
Findings of abdominal magnetic resonance cholangiopancreatography (MRCP).. MRCP image showing tapering of the gallbladder neck and cystic duct (arrow). The extrahepatic bile exhibits a V-shaped distortion (line) and the fundus of the gallbladder is displaced toward the abdominal center.
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The extrahepatic bile duct was distorted into a V shape (Fig. 3).
Intraoperative findings.. (a) Dark-red swollen gallbladder that is twisted by 360  in a counterclockwise rotation.. (b) Picture showing that the gallbladder was successfully removed.
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The operative findings indicated the presence of a dark-red swollen gallbladder that was twisted by 360  in a counterclockwise rotation, with the neck and cystic duct being rotated by 180  (Fig. 4a). After ligating the cystic artery and cystic duct, the gallbladder was successfully removed (Fig. 4b).
Histopathologic findings.. Histopathologic findings of the gallbladder showing acute and chronic cholecystitis with massive hemorrhage.
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Histopathologic findings of the gallbladder showed acute and chronic cholecystitis with massive hemorrhage (Fig. 5).