title: Acute torsion of the gall bladder in the aged: a re-emphasis on clinical diagnosis.
abstract: Three cases of torsion of the gall bladder in the aged are presented. From a review of the clinical features of these cases and the cases reported in the literature, a definite clinical pattern emerged. The clinical features can be grouped into three triads: a triad of the patient's characteristics which consists of a thin, old patient with chronic chest disease or a deformed spine; a triad of symptoms which consists of typical abdominal pain, early onset of vomiting and a short history; and a triad of physical signs which consists of an abdominal mass, a lack of toxaemia or jaundice and a discrepancy in the pulse and temperature. If most, if not all, of these features are present, torsion of the gall bladder should be presented. We re-emphasize that a clinical suspicion or diagnosis of torsion of the gall bladder is possible. The treatment is early cholecystectomy.
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008297:Male; D014102:Torsion Abnormality