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Torsion of the gallbladder, localized in right subphrenic space in a patient with liver cirrhosis

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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.

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Acknowledgments

We thank H. Yano, Y. Naito, H. Horiuchi, T. Hisaka, H. Ishikawa, R. Kawahara, H. Sakai, K. M. Akashi, Y. Goto, G. Nakayama, K. Takagi, Y. Nakama, K. Takahashi, Y. Nomura, S. Arai, N. Shirahama, S. Fukutomi, D. Muroya, and Y. Date (from Kurume University, Japan) for the fruitful discussion. We also thank A. Ohba and M. Toyofuku for the preparation of this manuscript.

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    Authors and Affiliations

    1. Department of Surgery, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan

      Yuichiro Maruyama, Yuya Tanaka, Masafumi Yasunaga, Hiroyuki Tanaka, Yoshito Akagi & Koji Okuda

    2. Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan

      Kei Ogata

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    1. Yuichiro Maruyama
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    2. Yuya Tanaka
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    3. Masafumi Yasunaga
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    4. Kei Ogata
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    5. Hiroyuki Tanaka
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    6. Yoshito Akagi
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    7. Koji Okuda
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    Correspondence to Yuichiro Maruyama.

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    Conflict of Interest:

    Yuichiro Maruyama, Yuya Tanaka, Masafumi Yasunaga, Kei Ogata, Hiroyuki Tanaka, Yoshito Akagi and Koji Okuda declare that they have no conflict of interest.

    Human/Animal Rights:

    All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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    Informed consent was obtained from all patients for being included in the study.

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    Y. Maruyama and Y. Tanaka contributed equally to this work.

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    Maruyama, Y., Tanaka, Y., Yasunaga, M. et al. Torsion of the gallbladder, localized in right subphrenic space in a patient with liver cirrhosis. Clin J Gastroenterol 8, 435–437 (2015). https://doi.org/10.1007/s12328-015-0618-3

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    • DOI: https://doi.org/10.1007/s12328-015-0618-3

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