A Clinician’s Guide to the Diagnosis and Management of Gallbladder Volvulus

Pottorf, Brian J.; Alfaro, Leonardo; Hollis, Harris W.

doi:10.7812/tpp/12-118

Cited by 31 publications

(76 citation statements)

References 20 publications

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“…Such a clinical course should alert the clinician of the possibility of GBV. Leucocytosis and raised C reactive protein are the usual laboratory findings which suggest inflammatory response which lacks specificity 2. Liver function tests are usually normal as in our patient who had leucocytosis and had essentially normal liver function tests.…”

Section: Discussionmentioning

confidence: 54%

Gallbladder volvulus with segmental right liver lobe hypoplasia/atrophy: a preoperative diagnostic dilemma

et al. 2018

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Gallbladder volvulus (GBV) due to rotation of the gall bladder (GB) around its own mesentery is a rare surgical emergency and often identified intraoperatively. Typically, cholecystitis is the initial clinical diagnosis, but a high index of suspicion on imaging can alert the physician for the possibility of GBV requiring urgent surgical intervention. We describe a case of a young female patient with hypoplasia/atrophy of the posterior segment of the right liver lobe and a GB with no hepatic attachments but only mesenteric pedicle. She presented with first episode of sudden-onset, severe right subcostal pain. The ultrasonogram and magnetic resonance cholangiopancreatogram findings were suggestive of GBV. She underwent laparoscopic exploration that confirmed GBV of a free-floating GB with a thrombosed cystic artery. The GB was detorted, and cholecystectomy was performed. She had an uneventful postoperative course and was discharged with no complications. Histopathological examination showed intramural haematoma of the GB with wall necrosis.

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Section: Discussionmentioning

confidence: 54%

Gallbladder volvulus with segmental right liver lobe hypoplasia/atrophy: a preoperative diagnostic dilemma

et al. 2018

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“…1,10 This case highlights a previously undescribed anatomical anomaly that may predispose to gallbladder torsion. 1,10 This case highlights a previously undescribed anatomical anomaly that may predispose to gallbladder torsion.…”

Section: Images For Surgeons E793mentioning

confidence: 87%

Interesting anatomical anomaly predisposing to gallbladder torsion

Kozman

Parikh

Fisher

2017

ANZ Journal of Surgery

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A 72-year-old female presents with sudden onset, severe, colicky, epigastric pain for 12 h following consumption of dinner. Associated nausea without vomiting was noted. No similar previous episodes are recalled. Past medical history included Parkinson's disease, hypothyroidism and hypertension. Regular medications included levodopa/carbidopa, thyroxine, aspirin and antihypertensives. She reports no past surgical history.On examination, she was afebrile and vital signs were normal. Her abdomen soft, but tender in the right hypochondrium, with positive Murphy's sign. No signs of peritonitis were elicited.Laboratory evaluations showed mild leucocytosis (11 × 10 9 /L) and elevated C-reactive protein (120). Other biochemical markers including liver function tests, lipase and troponins were normal. Biliary tract ultrasound revealed signs of cholecystitis, but no evidence of cholelithiasis (Fig. 1). The common bile duct meas-

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“…Review of the current literature shows that gallbladder volvulus commonly presents as an acute cholecystitis, although isolated cases of gallbladder torsion mimicking acute appendicitis have also been reported [6,8]. Since no single clinical, serologic, or radiographic finding is pathognomonic, this condition is often misdiagnosed as acute acalculous cholecystitis, making a correct preoperative diagnosis challenging [4,5,9]. According to a review by Reilly et al [4], a preoperative diagnosis of gallbladder torsion was made in 32 of 125 (26%) patients reported within the last 20 years and death as an outcome was reported in seven of the 113 patients presenting after 1991 representing a mortality rate of 6%.…”

Section: Discussionmentioning

confidence: 99%

“…In a review by Pottorf et al [5], absence of gallbladder fixation to the liver resulting in excessive mobilization ability of gallbladder, relaxation and atrophy of a previously normal mesentery in the elderly (also known as visceroptosis) causing mesenteric elongation and thinning, atherosclerosis of the cystic artery and a tortuous cystic duct, and congenital anomalies that predispose individuals to elongated mesenteries have been reported as possible explanations.…”

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confidence: 99%

“…While peristaltic movement of the stomach and colon have also been reported as a possible attribute to the torsion of the gallbladder, the mechanism of movement that may actually cause the torsion still remain unclear. Loss of visceral fat with liver atrophy from conditions such as ageing may also result in acquired long mesentery which may explain the increased incidence of gallbladder torsion in elderly thinner population [5]. Gallbladder torsion is more frequently encountered in the elderly population with 85% of the cases reported between the ages of 60 and 80 years.…”

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confidence: 99%

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Gallbladder torsion: A case study

Yasser¹,

Zukiwskyj²,

Lucky³

et al. 2016

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Torsion of the gallbladder is a rare condition and an important differential of an acute surgical abdomen. While early surgical intervention reduces the risk of disease progression to life-threatening complications, and thus avoids high morbidity and mortality, it is difficult to make a preoperative diagnosis of gallbladder torsion. Case Report: In this report, we describe a case of acute gallbladder torsion in an elderly male whose clinical presentation mimicked acute acalculous cholecystitis with local inflammatory reaction resulting from gangrenous gallbladder. The 81-year-old male was treated with emergency exploratory laparotomy. Except for developing an ileus requiring longer term recovery his post-operative period was otherwise uneventful and no further complications were evident in his follow-up clinic assessment. Conclusion:There is a wide range of differential diagnoses for patients presenting with acute surgical abdomen. Rare but life-threatening condition such as gallbladder torsion still remains a diagnostic challenge. Early diagnosis is the paramount in managing patients with gallbladder torsion as immediate surgical intervention is required. Keeping high index of clinical suspicion for patients presenting to emergency department with acute abdomen, especially in elderly population followed by diagnostic imaging can aid prompt diagnosis and thus facilitate early treatment.

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A Clinician’s Guide to the Diagnosis and Management of Gallbladder Volvulus

Cited by 31 publications

References 20 publications

Gallbladder volvulus with segmental right liver lobe hypoplasia/atrophy: a preoperative diagnostic dilemma

Gallbladder volvulus with segmental right liver lobe hypoplasia/atrophy: a preoperative diagnostic dilemma

Interesting anatomical anomaly predisposing to gallbladder torsion

Gallbladder torsion: A case study

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