Gallbladder volvulus overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
Overview
Volvulus is twisting of a non solid organ around its mesentric axis. Gallbladder volvulus is twisting or rotation of the gallbladder along the axis of the cystic duct and vascular pedicle (cystic artery).[1]
Historical Perspective
It was first described by Wendal in 1898.
Pathophysiology
Torsion of gall bladder leads to occlusion of the cystic duct and the cystic artery. This torsion can be complete (180o - 360o) or incomplete (< 180o). Incomplete torsion causes obstruction of the bile duct and vascular supply may be spared. In complete obstruction both are compromised. This occlusion leads to an increased amount of bile in the lumen and a decreased flow of blood to the organ. Increased pressure in the lumen with ischemia leads to acute inflammation causing a surgical emergency.
Diagnosis
History and Symptoms
Presentation of gallbladder volvulus is very non -specific. It is tough to diagnose based upon just the history and symptoms because patients present with acute abdominal pain with or without vomiting. At times there may be a tender mobile mass palpated suggestive of a floating gallbladder.