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\begin{document}

             \author[1]{Mounzer  Dgheem}

             \author[2]{Charles  Mouliade}

             \affil[1]{  Clinique Beau Soleil}

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\date{\small \em Received: 16 December 2013 Accepted: 5 January 2014 Published: 15 January 2014}

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\begin{abstract}
        


Gallbladder volvulus is an unusual cause of acute abdomen. After the first case published by Wendel, about 500 cases have been documented in the medical literature.This condition is defined as torsion of the gallbladder around its artery and duct in case of long and flask mesentery. The one presented here is a case of a 85 year-old woman who complained of right subcostal pain since 48 hours without fever. The echography revealed a large thick-walled gallbladder with a common bile duct diameter of 10mm without stones. Laparotomy through a right subcostal incision revealed a serohemorrhagic exudate with complete torsion of the gallbladder which was ischemic and gangrenous without perforation. Cholecysectomy was performed with a cholangiography which was normal. The anatomopathologic examination confirmed the diagnosis of acute gangrenous cholecystitis. Gallbladder volvulus is a nonfrequent cause of acute cholecystitis.

\end{abstract}


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\let\tabcellsep& 	 	 		 \par
Abstract-Gallbladder volvulus is an unusual cause of acute abdomen. After the first case published by Wendel, about 500 cases have been documented in the medical literature.This condition is defined as torsion of the gallbladder around its The one presented here is a case of a 85 year-old woman who complained of right subcostal pain since 48 hours without fever.\par
-walled gallbladder which was ischemic and gangrenous without perforation.\par
Cholecysectomy was performed with a cho langiography which was normal. The anatomopathologic examination confirmed the diagnosis of acute gangrenous cholecystitis. Gallbladder volvulus is a non-frequent cause of acute cholecystitis. 
\section[{I.}]{I.}\par
Case Report 85 year-old woman was admitted for a right upper abdominal pain, nausea, vomiting without abdominal surgery or trauma, laboratory analysis revealed hyperleucocytosis with normal liver function tests. The echography revealed thick-walled gallbladder without cholelithiasis and a common bile duct dilatation of 10 mm. Right upper quadrant tenderness and positive Murphy's sign were detected on physical examination. On surgical exploration through a right subcostal incision, there was a 100 ml of serohemorrhagic exudate with complete torsion of the gallbladder along the axis of the cystic duct (figure1), the cystic duct was so long which measured 6 cm, it is cut at a distance of 1 cm of the c ommon bile duct, introperativecholangiography was normal (figure2), standard open choecystectomy was performed. Bile culture was positive for Echerchia Coli, therefore; antibiotheraby was adapted. Her p ostoperative c ourse was uneventful, and she was discharged on the3 rd postoperative day.   
\section[{Discussion}]{Discussion}\par
Gallbladder volvulus is defined as torsion of the gallbladder around its artery and duct in case of a long and flask mesentery \hyperref[b0]{(1)}. After the first case published by Wendel in 1898(2), about 500 cases have been documented\par
-old patients \hyperref[b2]{(3,}\hyperref[b3]{4)}. Gallbladder torsion occurs most often in elderly patients \hyperref[b4]{(5,}\hyperref[b5]{6,}\hyperref[b6]{7)}, but several cases were rep orted in children \hyperref[b7]{(8,}\hyperref[b8]{9)}. The one presented here was a surprise intraoperative diagnosi s because of the presumed gallbladder volvulus commonly presents as acute cholecystitis and is rarely diagnosed preoperatively. This condition should be always suspected when making the patients especially in women. Magnetic resonance cholangiopancreatography (MRCP) i s very useful in making preoperative definitive diagnosis of gallbladder torsion \hyperref[b9]{(10)}. Gallbladder torsion was reported in pregnancy \hyperref[b10]{(11)}. Gallbladder volvulus should be thought suitable medical treatment. Delayed diagnosis can lead to dangerous c omplication such as necrosis and perforation of the gallbladder with a generalized peritonitis,consequently;mortality is increased especially in elderly patients who have often other comorbidities \hyperref[b4]{(5)}. laparoscopic detorsion and removal of gallbladder is the treatment of choice for gallbladder volvulus \hyperref[b3]{(4,}\hyperref[b11]{12)}. 
\section[{III.}]{III.} 
\section[{Conclusion}]{Conclusion}\par
Gallbladder volvulus is a rare cause of acute abdomen which i s rarely diagnosed before surgery. It should be added to the differential diagnosis of acute cholecystitis that does not improve after medical treatment especially in elderly women. Early diagnosis and urgent cholecystectomy in necessary for optimal prognosis.\par
Volume XIV Issue V Version I Year ( )\begin{figure}[htbp]
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\caption{\label{fig_0}}\end{figure}
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\noindent\textbf{1}\includegraphics[]{image-3.png}
\caption{\label{fig_1}Figure 1 :}\end{figure}
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\noindent\textbf{2}\includegraphics[]{image-4.png}
\caption{\label{fig_2}Figure 2 :}\end{figure}
 		 		\backmatter  			  				\begin{bibitemlist}{1}
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\bibitem[Bagnato et al. (2011)]{b5}\label{b5} 	 		\textit{Uncommon cause of ac ute abdomen: volvulus of gallbladder with necrosis. Case report and review of literature},  		 			C Bagnato 		,  		 			P Lippolis 		,  		 			G Zocco 		,  		 			C Galatioto 		,  		 			M Seccia 		.  		2011 Mar-Apr. Ann ItalChir. 82 p. .  	 
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\end{bibitemlist}
 			 		 	 
\end{document}
