Gallbladder Volvulus (Torsion) Treatment & Management

Updated: Nov 05, 2020
  • Author: Alan A Saber, MD, MS, FACS, FASMBS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Treatment

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. [19, 20, 21, 22]  Successful use of a robotic approach has been reported. [23]

Preoperative diagnosis of gallbladder torsion usually is difficult. [7] The most important differential diagnosis is acute cholecystitis. Advances in diagnostic imaging (see Workup), chiefly abdominal ultrasonography (US) and computed tomography (CT), 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. [24] The twisted gallbladder can tent the CBD, making it vulnerable to injury.

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