PMC6000732_01
CT Scan at time of admission demonstrates a large, distended gallbladder with normal wall thickness and common bile duct calibre. US scan demonstrating a mildly thickened gallbladder wall with no calculi.
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A subsequent ultrasound of her biliary system noted a distended gallbladder with increased wall thickness of 5 mm without hyperaemia or pericholecystic fluid [Fig. 1].
Left: Laparoscopic cholecystectomy: Intra-operative finding of a large, distended gangrenous gallbladder which has undergone a 180   anticlockwise torsion along the cystic duct and artery. Right: Laparoscopic cholecystectomy: Unwinding the torted gallbladder reveals a loose strand of mesentery as the only attachment for the gallbladder to the liver.
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Intra-operatively, the gallbladder was found to be loosely adherent to the inferior aspect of the liver and was malrotated 180   anticlockwise along the axis of the cystic duct and artery resulting in distension and gangrene [Fig. 2].
Post-operative examination of the resected specimen demonstrates a 75 mm long, thin walled gallbladder with extensive areas of necrosis.
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The wall thickness predominantly measured 1 mm with an area of congestion at the fundus measuring 5 mm [Fig. 3].