PMC3021298_01
Abdominal ultrasound showing the gallbladder with thickened wall and a hyperechogenic image suggesting the torsed mesentery. The US Doppler shows no flow within the gallbladder.
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F1
The abdominal US revealed acute lithiasic cholecystitis with dilation of intra- and extrahepatic biliary ducts, main bile duct of 9 mm, gallbladder measuring 11.5 cm x 4.8 cm x 7.3 cm, with thickened wall measuring 5 mm to 8.2 mm in the neck, the presence of mobile hyperechogenic images compatible with stones and perivesicular collection (Figure 1).
Abdominal computed tomographic scan showing an enlarged gallbladder with asymmetric thickening of the wall with a low-density filling.
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F2
An abdominal CT showed an ovoid image measuring 11 cm x 7 cm with asymmetric thickening of the wall with low-density filling and an ovoid image in the interior measuring 2 cm in diameter, suggesting the presence of a stone (Figure 2).
Necrotic floating gallbladder found at laparoscopy. Free necrotic gallbladder with a 360  counterclockwise torsion in its mesentery.
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F3
Laparoscopic detorsion and cholecystectomy were performed by clipping and cutting the cystic duct and the cystic artery without complications (Figure 3).
Open gallbladder showing the thickened wall and the presence of 2 gallstones.
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F4
The pathological examination of the specimen revealed a 15-cm x 13-cm x 0.4-cm gallbladder with a 0.3-cm wall and the presence of 2 cholesterol calculi measuring 2 cm each (Figure 4).