title: Torsion of the gallbladder, localized in right subphrenic space in a patient with liver cirrhosis.
abstract: We report a case of torsion of the gallbladder displaced under the right subphrenic space in a patient with liver cirrhosis. An 82-year-old Japanese woman was admitted to our hospital for acute pain in the right upper quadrant. Clinical features suggested gallbladder torsion. She was under treatment for hepatitis C virus-related cirrhosis at our hospital. Abdominal CT showed the swollen fundus and body of the gallbladder under the right subphrenic space. Emergency laparoscopic cholecystectomy was performed. Intraoperative findings included a grossly necrotic gallbladder in the right subphrenic space with 360° clockwise torsion, together with liver cirrhosis and localized peritonitis. The clinical features and imaging findings in this rare case of misplaced gallbladder in right subphrenic space resembled those described in typical strangulated gallbladder. The displacement was probably related to right liver lobe atrophy associated with liver cirrhosis. Appropriate diagnosis and prompt surgical treatment are essential for a positive outcome.
authors.affiliation: Department of Surgery, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan. yumaruyama@med.kurume-u.ac.jp.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maruyama
authors.affiliation: Department of Surgery, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Yasunaga
authors.affiliation: Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Ogata
authors.affiliation: Department of Surgery, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Akagi
authors.affiliation: Department of Surgery, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Okuda
mesh_terms: D000369:Aged, 80 and over; D001284:Atrophy; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D014102:Torsion Abnormality / Q000473:pathology* / Q000601:surgery
keywords: Liver cirrhosis; Right subphrenic space; Torsion of gallbladder