title: Laparoscopic management of a two staged gall bladder torsion.
abstract: Gall bladder torsion (GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel's lobe (part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful post-operative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot's triangle. Laparoscopic cholecystectomy has the benefit of early recovery.
authors.affiliation: Yadav Kamal Sunder, Sali Priyanka Akhilesh, Garg Raman, Mehta Hitesh Shantilal, G.I. Surgery Department, Lilavati Hospital and Research Centre, Mumbai, Maharashtra 400050, India.
authors.forename: Yadav Kamal
authors.initials: YK
authors.lastname: Sunder
authors.affiliation: Yadav Kamal Sunder, Sali Priyanka Akhilesh, Garg Raman, Mehta Hitesh Shantilal, G.I. Surgery Department, Lilavati Hospital and Research Centre, Mumbai, Maharashtra 400050, India.
authors.forename: Sali Priyanka
authors.initials: SP
authors.lastname: Akhilesh
authors.affiliation: Yadav Kamal Sunder, Sali Priyanka Akhilesh, Garg Raman, Mehta Hitesh Shantilal, G.I. Surgery Department, Lilavati Hospital and Research Centre, Mumbai, Maharashtra 400050, India.
authors.forename: Garg
authors.initials: G
authors.lastname: Raman
authors.affiliation: Yadav Kamal Sunder, Sali Priyanka Akhilesh, Garg Raman, Mehta Hitesh Shantilal, G.I. Surgery Department, Lilavati Hospital and Research Centre, Mumbai, Maharashtra 400050, India.
authors.forename: Sharma
authors.initials: S
authors.lastname: Deborshi
authors.affiliation: Yadav Kamal Sunder, Sali Priyanka Akhilesh, Garg Raman, Mehta Hitesh Shantilal, G.I. Surgery Department, Lilavati Hospital and Research Centre, Mumbai, Maharashtra 400050, India.
authors.forename: Mehta Hitesh
authors.initials: MH
authors.lastname: Shantilal
keywords: Gall bladder torsion; Gangrenous gall bladder; Laparoscopic cholecystectomy; Perforated gall bladder; Two staged torsion of the gall bladder