Gallbladder volvulus

Gallbladder Volvulus: Diagnosis and Management of a Rare Cause of Acalculous Cholecystitis

“…Since the first description of a gallbladder volvulus in 1898 by Wendel, more and more cases have been reported in literature [1]. A recent literature review by Moser et al reported 477 cases of gallbladder volvulus [2]. Considering the great number of cholecystectomies performed every year all over the world it can be considered an extremely rare condition.…”

“…Considering the great number of cholecystectomies performed every year all over the world it can be considered an extremely rare condition. It presents a peak of incidence in elderly patients (>70 years) with a male/female ratio of 5:1 [2][3][4]. These patients often come to physicians' attention for an acute cholecystitis-like syndrome, but it is not uncommon a septic presentation with peritonitis [5].…”

“…In Type B anomaly, the gallbladder is detached from the liver and the infundibulum and the cystic duct are connected to the lower face of the liver by a long peritoneal fold whose short implant base can lead to gallbladder torsion on its long axis. Other classifications have been reported since gallbladder rotation can be complete (more than 180º) or incomplete (less than 180º), clockwise or anti-clockwise [2,5]. The higher incidence of gallbladder volvulus in the elderly can be explained by the association of predisposing anatomic anomalies with age-dependent tissue alteration such as reduction in body visceral fat and tissue elasticity, spinal deformations and visceral ptosis [8].…”

“…The higher incidence of gallbladder volvulus in the elderly can be explained by the association of predisposing anatomic anomalies with age-dependent tissue alteration such as reduction in body visceral fat and tissue elasticity, spinal deformations and visceral ptosis [8]. Increased colonic and gastric peristalsis, stypsis, abdominal traumas or visceral adhesions, can act as triggers for gallbladder torsion [2]. Independently from its pathophysiologic etiology, gallbladder volvulus often presents as an acute event characterized by a clinical presentation similar to acute lithiasic cholecystitis.…”

“…Cholecystectomy is indeed the gold standard for treatment. Medical treatment is generally unsuccessful and surgery delay is associated to a high rate of septic complications (16%) and mortality (4.9-6%) [2,13]. When a volvulus occurs, blood supply is compromised by cystic artery torsion, resulting in ischaemia and necrotic cholecystitis.…”