Gallbladder volvulus
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At the time the article was created Manchikanti Venkatesh had no recorded disclosures.
View Manchikanti Venkatesh's current disclosuresAt the time the article was last revised Jeremy Jones had no recorded disclosures.
View Jeremy Jones's current disclosures- Gallbladder volvulus
- Volvulus of gallbladder
- Torsion of the gallbladder
- Gallbladder torsion
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.
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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.
References
- 1. Smith E, Dillman J, Elsayes K, Menias C, Bude R. Cross-Sectional Imaging of Acute and Chronic Gallbladder Inflammatory Disease. AJR Am J Roentgenol. 2009;192(1):188-96. doi:10.2214/ajr.07.3803
- 2. Matsuhashi N, Satake S, Yawata K et al. Volvulus of the Gall Bladder Diagnosed by Ultrasonography, Computed Tomography, Coronal Magnetic Resonance Imaging and Magnetic Resonance Cholangio-Pancreatography. World J Gastroenterol. 2006;12(28):4599-601. doi:10.3748/wjg.v12.i28.4599
- 3. Kachi A, Nicolas G, Nasser J, Hashem M, Abou Sleiman C. A Rare Presentation of Gall Bladder Volvulus: A Case Report. Am J Case Rep. 2019;20:1466-70. doi:10.12659/ajcr.916234
- 4. Layton B, Rudralingam V, Lamb R. Gallbladder Volvulus: It’s a Small Whirl. BJR|case reports. 2016;2(3):20150360. doi:10.1259/bjrcr.20150360
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