Gallbladder volvulus

Last revised by Jeremy Jones on 20 Sep 2021

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.

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.

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. 

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

Cholecystectomy is the preferred treatment.

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Cases and figures

  • Case 1
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