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Gallbladder Volvulus Workup

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

Laboratory Studies

At the beginning of the presentation, the white blood cell (WBC) count invariably is within the reference range, but as vascular compromise develops and gangrene sets in, the WBC count climbs to abnormal values.[6]

The results of liver function tests usually are normal because the common bile duct (CBD) is not obstructed; however, patients may have some mild increases in these values.[6]


Imaging Studies

A preoperative diagnosis can be made by means of imaging techniques (eg, ultrasonography or computed tomography [CT][8, 9] ).

Ultrasonographic evaluation appears to be the most reliable diagnostic imaging modality. A large, anteriorly floating gallbladder without gallstones and a conical appearance of the neck with discontinuity of the lumen suggest torsion. Thumbprinting of the gallbladder wall is an indirect sign of a gangrenous process. Nonspecific findings of gross wall thickening, gallbladder distention, and absence of calculi can be present in torsion and in calculus cholecystitis. The so-called cystic duct knot sign has been suggested as a potentially useful ultrasonographic sign for identifying gallbladder volvulus preoperatively.[10]

A floating gallbladder sign (ie, a large, anteriorly floating gallbladder without gallstones) on ultrasonography or CT is observed most commonly in patients with torsion of the gallbladder.[11] Whirl sign from gallbladder torsion has been found on contrast-enhanced multidetector CT scans.[12]

Depending on the degree of torsion, a hepatoiminodiacetic acid (HIDA) scan may aid in visualizing the gallbladder. The scintigraphic appearance of gallbladder torsion includes a bull's eye and a fusiform CBD as a result of the superimposed floating gallbladder apposed against the anterior abdominal wall.

Magnetic resonance cholangiopancreatography (MRCP) may be useful in diagnosing gallbladder torsion.[13] MRCP can show a V-shaped distortion of the extrahepatic bile ducts due to traction by the cystic duct, tapering and twisting interruption of the cystic duct, a distended gallbladder, and a difference in intensity between the gallbladder and extrahepatic bile ducts and the cystic duct.


Histologic Findings

Findings consistent with an acute hemorrhagic infarct are present in gallbladder volvulus.

Contributor Information and Disclosures

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.


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.


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.

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