Gallbladder Volvulus Treatment & Management
- Author: Alan A Saber, MD, MS, FACS; Chief Editor: John Geibel, MD, DSc, MSc, MA more...
Gallbladder volvulus, or torsion of the gallbladder, should be treated with prompt cholecystectomy. Laparoscopic cholecystectomy is feasible and safe in the treatment of gallbladder volvulus, allowing a faster patient recovery and a shorter hospital stay than open cholecystectomy does.[14, 15, 16]
Preoperative diagnosis of gallbladder torsion usually is difficult. The most important differential diagnosis is acute cholecystitis. Advances in diagnostic imaging, chiefly abdominal ultrasonography and CT (see Workup), have been accompanied by increases in the number of cases reported to have been diagnosed preoperatively.
Evacuation of the gallbladder may be necessary to allow grasping with instruments. Detorsion of the gallbladder must be accomplished first. This avoids tenting of and possible injury to the common bile duct (CBD).
The CBD may be injured during ligation of the cystic duct. The twisted gallbladder can tent the CBD, making it vulnerable to injury.
Faure JP, Doucet C, Scepi M, et al. Abnormalities of the gallbladder, clinical effects. Surg Radiol Anat. 2008 Jun. 30(4):285-90. [Medline].
Mouawad NJ, Crofts B, Streu R, Desrochers R, Kimball BC. Acute gallbladder torsion - a continued pre-operative diagnostic dilemma. World J Emerg Surg. 2011 Apr 13. 6(1):13. [Medline]. [Full Text].
Reilly DJ, Kalogeropoulos G, Thiruchelvam D. Torsion of the gallbladder: a systematic review. HPB (Oxford). 2012 Oct. 14(10):669-72. [Medline]. [Full Text].
Pu TW, Fu CY, Lu HE, Cheng WT. Complete body-neck torsion of the gallbladder: a case report. World J Gastroenterol. 2014 Oct 14. 20 (38):14068-72. [Medline].
Pottorf BJ, Alfaro L, Hollis HW. A Clinician's Guide to the Diagnosis and Management of Gallbladder Volvulus. Perm J. 2013 Spring. 17(2):80-3. [Medline]. [Full Text].
Janakan G, Ayantunde AA, Hoque H. Acute gallbladder torsion: an unexpected intraoperative finding. World J Emerg Surg. 2008 Feb 22. 3:9. [Medline]. [Full Text].
Shaikh AA, Charles A, Domingo S, Schaub G. Gallbladder volvulus: report of two original cases and review of the literature. Am Surg. 2005 Jan. 71(1):87-9. [Medline].
Hinoshita E, Nishizaki T, Wakasugi K, et al. Pre-operative imaging can diagnose torsion of the gallbladder: report of a case. Hepatogastroenterology. 1999 Jul-Aug. 46(28):2212-5. [Medline].
Katz DS, Yam B, Hines JJ, et al. Uncommon and unusual gastrointestinal causes of the acute abdomen: computed tomographic diagnosis. Semin Ultrasound CT MR. 2008 Oct. 29(5):386-98. [Medline].
Dasyam AK, Koo J, Stahlfeld Miller M, Sell HW Jr, Tublin ME. The cystic duct knot sign: case report with description of a new ultrasound sign of gallbladder torsion. Emerg Radiol. 2015 Aug. 22 (4):445-7. [Medline].
Coquaz S, Bruant P, Regenet N, et al. [Gallbladder volvulus: two cases report]. Ann Chir. 2005 Apr. 130(4):252-3. [Medline].
Tajima Y, Tsuneoka N, Kuroki T, et al. Clinical images. Gallbladder torsion showing a "whirl sign" on a multidetector computed tomography scan. Am J Surg. 2009 Jan. 197(1):e9-10. [Medline].
Fukuchi M, Nakazato K, Shoji H, Naitoh H, Kuwano H. Torsion of the gallbladder diagnosed by magnetic resonance cholangiopancreatography. Int Surg. 2012 Jul-Sep. 97(3):235-8. [Medline]. [Full Text].
Kim SY, Moore JT. Volvulus of the gallbladder: laparoscopic detorsion and removal. Surg Endosc. 2003 Nov. 17(11):1849. [Medline].
Kimura T, Yonekura T, Yamauchi K, et al. Laparoscopic treatment of gallbladder volvulus: a pediatric case report and literature review. J Laparoendosc Adv Surg Tech A. 2008 Apr. 18(2):330-4. [Medline].
Vosswinkel JA, Colantonio AL. Torsion of the gallbladder: laparoscopic identification and treatment. Surg Endosc. 1999 Nov. 13(11):1154-6. [Medline].