Gallbladder volvulus

Gallbladder volvulus is a relatively rare condition in which there is a rotation of the gallbladder around the axis of the cystic duct and artery.

Clinical presentation

Symptoms are non-specific, however right upper quadrant pain and vomiting are similar to biliary colic. Laboratory evaluations are often non-specific. If there is fever or leukocytosis, then acute cholecystitis may have developed.

Pathology

It has been observed on patients with significant weight loss, in which there is loss of pericholecystic fat. 

Complications are related to torsion with vascular compromise and resultant gallbladder ischemia. In this condition both gangrenous change and perforation may occur. 

Radiographic features

Ultrasound

• large floating gallbladder
• wall thickening
• gallbladder outside the normal anatomical fossa

CT

• massively distended gallbladder
• pericholecystic fluid 
• gallbladder outside the normal anatomical fossa
• change in anatomical orientation, from vertical to horizontal ³
• indrawing of the vascular pedicle and surrounding fat ("swirl" sign) ⁴
• loss of enhancement
• abrupt tapering of cystic duct ("bird beak" sign)

Treatment

Cholecystectomy is the preferred treatment.