Gallbladder volvulus pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Pathophysiology
Torsion of gall bladder leads to occlusion of cystic duct and artery. This torsion can be complete (180o - 360o) or incomplete(< 180o). Incomplete torsion causes obstruction to bile duct and vascular supply may be spared. In complete obstruction both are compromised.[1] 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. [2]
- Findings may be similar to gangrenous cholecystitis due to severe ischemia.
- The GB wall shows almost complete coagulation necrosis with intramural hemorrhages.
- A thin layer of degenerated collagen fiber, derived from the mucosa and proper muscle, may be seen along the inner side, and a thin subserosal connective tissue layer may seen along the outermost side.