Diagnostic Dilemmas and Classics of Surgical Treatment in Gallbladder Torsion

Abstract

Introduction. Gallbladder torsion is an extremely rare condition in pediatric practice, characterized by the rotation of the organ around its axis, leading to impaired blood flow and potential tissue necrosis. The limited number of reported cases in children complicates early diagnosis and the development of an effective treatment strategy. While this pathology is typically observed in elderly patients, it remains an exceptional finding in children.
Objective — to present a rare case of gallbladder torsion in a child, highlighting diagnostic challenges and surgical management.
Methods. Clinical observation, laboratory and instrumental studies, laparoscopic surgery, and histological examination.
Results. A 6-year-old boy was admitted to the hospital with complaints of severe abdominal pain and episodes of vomiting after eating, lasting for the previous 24 hours. Physical examination revealed significant tenderness and moderate muscle tension in the right upper abdominal quadrant. Body temperature remained normal. Laboratory tests showed moderate leukocytosis with neutrophilic predominance; biochemical parameters were within normal limits. Abdominal ultrasound revealed thickened, multilayered gallbladder walls, heterogeneous contents with echogenic particles, and signs of surrounding tissue edema. Mild dilation of intrahepatic bile ducts and free fluid in the abdominal cavity and pelvis were also noted.
Conclusion. Gallbladder torsion in children is an exceptionally rare condition that requires increased clinical vigilance. Its presentation is nonspecific and may mimic other acute abdominal surgical conditions. Accurate early diagnosis remains challenging. Imaging techniques such as ultrasound and Doppler examination of the suspected area (gallbladder region) may provide important diagnostic clues, though definitive confirmation is usually made intraoperatively. Timely surgical intervention is crucial in preventing severe complications such as gallbladder rupture, peritonitis, and sepsis. Emergency laparoscopic cholecystectomy is considered the preferred treatment for this pathology.

Acknowledgments
The authors would like to express their gratitude to the staff of Children’s City Clinical Hospital No. 9 (Ekaterinburg) for their assistance with follow-up care and provision of clinical materials.

For citation
Timoshinov MYu, Tsap NA, Ekimov MN. Diagnostic dilemmas and classics of surgical treatment in gallbladder torsion. USMU Medical Bulletin. 2025;10(3):e00180. (In Russ.). DOI: https://doi.org/10.52420/usmumb.10.3.e00180. EDN: https://elibrary.ru/OYIPCR.