Gallbladder Volvulus (Torsion) Workup

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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Workup

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. [7]

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. [7]

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Imaging Studies

A preoperative diagnosis can be made by means of imaging techniques (eg, ultrasonography [US] or computed tomography [CT] [11, 12] ).

US appears to be the most reliable diagnostic imaging modality in this setting. 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 calculous cholecystitis. The so-called cystic duct knot sign has been suggested as a potentially useful ultrasonographic sign for identifying gallbladder volvulus preoperatively. [13]

A floating gallbladder sign (ie, a large, anteriorly floating gallbladder without gallstones) on US or CT is observed most commonly in patients with torsion of the gallbladder. [14] Whirl sign from gallbladder torsion has been found on contrast-enhanced multidetector CT scans. [15]

Depending on the degree of torsion, a hepatoiminodiacetic acid (HIDA) scan may aid in visualizing the gallbladder. [16] 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. [17]  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. Diffusion-weighted magnetic resonance imaging (MRI) may help rule out a malignant process. [18]

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Histologic Findings

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

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