Gallbladder volvulus

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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]

Synonyms and keywords: Torsion of gallbladder;

Overview

Twisting or rotation of gall bladder along the axis of cystic duct and vascular pedicle(cystic artery).

Historical Perspective

It was first described by Wendal in 1898.

Pathophysiology

Torsion of gall bladder leads to occlusion of cystic duct and artery. This torsion can be complete (360 ^o) or incomplete. This occlusion leads to increase in bile in the lumen and decreased flow of blood to the organ. Increased pressure in the lumen with ischemia leads to acute inflammation causing surgical emergency.

Gross Pathology

• Enlarged and distended gallbladder.
• Torsion along the long axis of the peduncle.
• Thick edematous wall with mucosal congestion.

Microscopic Pathhology

• Extensive necrosis of the wall
• Findings may be similar to gangrenous cholecystitis due to severe ischemia.

Causes

Volvulus of gallbladder is known to be caused due to

• Inherent causes
  • Floating gallbladder
• Acquired causes
  • Splanchnoptosis
  • Senile humpback
• Physical causes
  • Sudden changes of intraperitoneal pressure
  • Sudden changes of body position
  • Hyperperistalsis of organs near the gallbladder
  • Defecation
  • Trauma to the abdomen

Epidemiology and Demographics

Over 500 cases have been documented since its description in 1898.

Age

• Few cases are reported in pediatric population.
• 85% of the cases are reported in 60 - 80 age group.

Gender

• There is a female preponderance for this condition.
• Female to male ratio is 3:1.

Risk Factors

Risk factors for gallbladder volvulus include

• Hyperperistalsis
• Scoliosis
• Weight loss
• Multiparity

Cholelithiasis as a risk factor is still uncertain.