Gallbladder volvulus: A rare case of acute cholecystitis

Gallbladder volvulus mimicking a cardiac event – an unusual presentation

“…Although it can occur in all age groups, with some paediatric cases reported [4,6], advanced age is an important characteristic as it relates to visceroptosis, a concept in which mesentery atrophies, elongates and becomes more fl exible over time, which can cause the gallbladder to become less fi rmly attached to its liver fossa, or "fl oat", and predispose it to torsion [2,4].…”

“…Patients most commonly present with symptoms mirroring acute cholecystitis [6,7]. On clinical examination there may be a positive Murphy's sign or a palpable mass in the right upper quadrant [2,6,7]. Other differential diagnoses include biliary colic, ascending cholangitis, pyelonephritis and right-sided colon malignancy.…”

“…Ultrasonography may show a diffusely thickened and hypoechoic gallbladder wall indicating infl ammation and/or gangrene, a gallbladder not adherent to its bed, and multiple linear echoes converging to form a cone tip at the gallbladder neck [8]. CT may show a distended gallbladder outside of its fossa with wall thickening and oedema, with the cystic artery classically located to its right, together torsion of its cystic pedicle causing a "whirl sign" [6,9]. MRI is the most sensitive, with T2 weighted images useful in showing gallbladder wall necrosis, but this is rarely used in the emergency setting [3,9].…”

Volvulus de la vésicule biliaire

“…Il peut être expliqué par deux anomalies anatomiques [1,2] type B, la vésicule et le cystique sont amarrés à la face inférieure du foie par un méso trop court. Ces anomalies de migration embryologique de la vésicule, associées à la perte de graisse et d'élasticité chez la personne âgée, favorisent la viscéroptose et la mobilité de l'organe [3]. Le volvulus de la vésicule biliaire est une urgence chirurgicale qui nécessite un diagnostic et une intervention rapide afin d'éviter la péritonite biliaire par perforation de la vésicule biliaire nécrosée.…”

A Gallbladder Volvulus Presenting as Acute Cholecystitis in a Young Woman

“…In this case, it attaches only at the cystic duct and its associated vascular cystic pedicle, allowing for it to rotate along its axis; this is known as a floating or pedunculated gallbladder [1]. This predisposition is not just a congenital explanation for possible occurrence in children; loss of fatty and elastic tissue and liver atrophy with or without increased peristalsis from the surrounding bowel and kyphoscoliosis are factors that help explain gallbladder volvulus in older women being more common [1][2][3]. Indeed, Reilly et al reviewed a total of 324 patients related to gallbladder torsion reported since 1898.…”