case_images: PMC11169684_01
case_images: (A) Abdominal ultrasound showed a cystic area of 7.2 cm x 3.1 cm x 3.8 cm in the right upper abdomen, with clear boundaries and sound transmission. (B) Abdominal ultrasound showed a cystic area of 2.7 cm x 1.1 cm x 1.4 cm at the gallbladder fossa, with clear boundaries and sound transmission. (C,D) Abdominal CT showed an oval low-density shadow, about 65 mm x 26 mm x 30 mm in size, with a clear boundary in the right upper abdomen (lower edge of the liver). The gallbladder was not clear, and cystic shadow was seen in the gallbladder fossa area, and the common bile duct was slightly dilated. (E) Coronal T2-W MRI showed that there was no normal gallbladder and cystic duct in the gallbladder fossa area, an ovoid cystic high signal was seen in the lower layer of the gallbladder fossa, and a tortuous tubular structure was seen in the anterior superior layer to the direction of the gallbladder fossa. (F) Sagittal T2-W MRI showed that there was no normal gallbladder and cystic duct in the gallbladder fossa area, and the oval cystic high signal was observed at the level below the gallbladder fossa. (G) Horizontal T2-W MRI showed an ovoid cystic high signal (52 mm x 30 mm) below the gallbladder fossa, and the fluid signal was seen around the cystic structure. (H) MRCP showed a tortuous tubular structure above the gallbladder, which was highly suspected of gallbladder torsion.
case_images: fmed-11-1407716-g001.jpg
case_images: PMC11169684_01_fmed-11-1407716-g001.jpg
case_images: fig1
case_images: Emergency B-ultrasound examination revealed a cystic area of 7.2 cm x 3.1 cm x 3.8 cm in the right upper abdomen, with clear boundaries and sound transmission (Figure 1A). A cystic area of 2.7 cm x 1.1 cm x 1.4 cm could be detected at the gallbladder fossa, with clear boundaries and sound transmission inside (Figure 1B). The gallbladder was not clear, the cystic shadow was seen in the gallbladder fossa area, and the common bile duct was slightly dilated, which was considered to be a benign lesion (Figures 1C,D). There was a high suspicion of a free gallbladder with torsion (Figures 1E-H).
case_images: (A) The floating gallbladder was found during laparoscopic exploration. (B) Below the lower margin of the liver, numerous tortuous and infarcted omentum can be seen. (C) The gallbladder neck was reversed by 720 degrees counterclockwise. (D) Dilated cystic nodules in the uninvolved part of the neck of the gallbladder. (E) Gross appearance of the resected gallbladder, size about 7.0 cm x 3.0 cm. (F) When the gallbladder was opened, colorless transparent thin bile was found. (G,H) Pathological picture of the gallbladder after resection (HE staining, G x 40, H x 100).
case_images: fmed-11-1407716-g002.jpg
case_images: PMC11169684_01_fmed-11-1407716-g002.jpg
case_images: fig2
case_images: During the operation, the gallbladder was found to be free and slightly congested, about 7.0 cm x 3.0 cm in size, and the wall of the gallbladder was slightly thick (Figure 2A). The bottom of the gallbladder was adhered to the greater omentum, and the cystic duct was entangled with part of the greater omentum and rotated counterclockwise for 720  (Figures 2B-D). The gallbladder was carefully separated and completely removed, the cystic artery was ligated, and the abdominal drainage tube was placed (Figures 2E,F). Adhesion of omental tissue was seen at the base of the gallbladder (Figures 2G,H).