Gallbladder volvulus

WikiDoc Resources for Gallbladder volvulus
Articles
Most recent articles on Gallbladder volvulus Most cited articles on Gallbladder volvulus Review articles on Gallbladder volvulus Articles on Gallbladder volvulus in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Gallbladder volvulus Images of Gallbladder volvulus Photos of Gallbladder volvulus Podcasts & MP3s on Gallbladder volvulus Videos on Gallbladder volvulus
Evidence Based Medicine
Cochrane Collaboration on Gallbladder volvulus Bandolier on Gallbladder volvulus TRIP on Gallbladder volvulus
Clinical Trials
Ongoing Trials on Gallbladder volvulus at Clinical Trials.gov Trial results on Gallbladder volvulus Clinical Trials on Gallbladder volvulus at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Gallbladder volvulus NICE Guidance on Gallbladder volvulus NHS PRODIGY Guidance FDA on Gallbladder volvulus CDC on Gallbladder volvulus
Books
Books on Gallbladder volvulus
News
Gallbladder volvulus in the news Be alerted to news on Gallbladder volvulus News trends on Gallbladder volvulus
Commentary
Blogs on Gallbladder volvulus
Definitions
Definitions of Gallbladder volvulus
Patient Resources / Community
Patient resources on Gallbladder volvulus Discussion groups on Gallbladder volvulus Patient Handouts on Gallbladder volvulus Directions to Hospitals Treating Gallbladder volvulus Risk calculators and risk factors for Gallbladder volvulus
Healthcare Provider Resources
Symptoms of Gallbladder volvulus Causes & Risk Factors for Gallbladder volvulus Diagnostic studies for Gallbladder volvulus Treatment of Gallbladder volvulus
Continuing Medical Education (CME)
CME Programs on Gallbladder volvulus
International
Gallbladder volvulus en Espanol Gallbladder volvulus en Francais
Business
Gallbladder volvulus in the Marketplace Patents on Gallbladder volvulus
Experimental / Informatics
List of terms related to Gallbladder volvulus

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

Volvulus is twisting of a non solid organ around its mesentric axis. Gallbladder volvullus is 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 (180^o - 360^o) or incomplete(< 180^o). Incomplete torsion causes obstruction to bile duct and vascular supply may be spared. In complete obstruction both are compromised. 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 Pathology

• 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.

Natural History, Complications and Prognosis

Complications

• Acute perforation
• Bilious peritonitis
• Bowel adhesion's
• Gallbladder necrosis
• Gangrenous cholecystitis
• Sepsis

Prognosis

• It has favorable a prognosis due to early diagnosis and prompt treatment.
• With immediate surgery the mortality rate is less than 5%.

Diagnosis

History

A directed history should be obtained to ascertain

Symptoms

"Type symptom here" is pathognomonic of the "type disease name here".

"Type non specific symptoms" may be present.

Social History

Alcohol

The frequency and amount of alcohol consumption should be characterized.