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Gallbladder Volvulus Treatment & Management

  • Author: Alan A Saber, MD, MS, FACS; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
 
Updated: Jul 15, 2016
 

Surgical Therapy

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.[6] 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).

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Complications

The CBD may be injured during ligation of the cystic duct. The twisted gallbladder can tent the CBD, making it vulnerable to injury.

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Contributor Information and Disclosures
Author

Alan A Saber, MD, MS, FACS FASMBS, Director of Bariatric and Metabolic Surgery, University Hospitals Case Medical Center; Surgical Director, Bariatric Surgery, Metabolic and Nutrition Center, University Hospitals Digestive Health Institute; Associate Professor of Surgery, Case Western Reserve University School of Medicine

Alan A Saber, MD, MS, FACS is a member of the following medical societies: American College of Surgeons, American Society for Metabolic and Bariatric Surgery, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Raul J Rosenthal, MD, FACS, FASMBS Professor of Surgery, Chairman, Section of Minimally Invasive Surgery and The Bariatric and Metabolic Institute, Program Director, Fellowship in Minimally Invasive Surgery, Herbert Wertheim School of Medicine, Florida International University

Raul J Rosenthal, MD, FACS, FASMBS is a member of the following medical societies: American College of Surgeons, American Society for Metabolic and Bariatric Surgery, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

David L Morris, MD, PhD, FRACS Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: Received none from RFA Medical for director; Received none from MRC Biotec for director.

Chief Editor

John Geibel, MD, DSc, MSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Additional Contributors

Oscar Joe Hines, MD Assistant Professor, Department of Surgery, University of California at Los Angeles School of Medicine

Oscar Joe Hines, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Endocrine Surgeons, American College of Surgeons, Association for Academic Surgery, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases wish to acknowledge Danny Rosin, MD, Instructor, Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel, for his previous association with this article.

References
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  2. 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].

  3. Reilly DJ, Kalogeropoulos G, Thiruchelvam D. Torsion of the gallbladder: a systematic review. HPB (Oxford). 2012 Oct. 14(10):669-72. [Medline]. [Full Text].

  4. 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].

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  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

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  12. 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].

  13. 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].

  14. Kim SY, Moore JT. Volvulus of the gallbladder: laparoscopic detorsion and removal. Surg Endosc. 2003 Nov. 17(11):1849. [Medline].

  15. 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].

  16. Vosswinkel JA, Colantonio AL. Torsion of the gallbladder: laparoscopic identification and treatment. Surg Endosc. 1999 Nov. 13(11):1154-6. [Medline].

 
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