Research Day

Challenges In The Diagnosis Of Gallbladder Volvulus

Document Type

Abstract

Date

2019

Abstract

BACKGROUND: Gallbladder volvulus is a rare condition that poses a challenge to surgeons and radiologists due to its overlapping presentation with acute cholecystitis. First identified in 1898, only 500 cases have since been documented in the literature. Here, we present a rare case of gallbladder volvulus managed successfully with an emergent cholecystectomy.

METHODS: Materials for this case report were obtained through chart review and photographs taken peri-operatively by the authors.

CASE PRESENTATION: A 95 year-old female presented with diffuse right upper quadrant abdominal pain. CT scan of the abdomen revealed a distended, oddly-shaped cystic structure in the region of the gallbladder fossa. The official radiology report noted that the structure possibly represented the gallbladder, although it appeared oddly-shaped. Further investigation with a HIDA scan and right upper quadrant ultrasound created a high suspicion for cholecystitis prompting surgical intervention, which revealed a necrotic bile-filled gallbladder that had twisted on its mesentery. Following cholecystectomy, the patient made a full recovery with no complications.

DISCUSSION: Gallbladder volvulus classically affects elderly patients between the ages of 60 and 80 with a 3:1 female predominance. This is likely due to a loss of visceral fat predisposing the gallbladder to rotate along the axis of the cystic duct and artery. Signs and symptoms closely mimic cholecystitis, but pre-operative diagnosis is quite difficult due to inconclusive radiologic findings. Prompt identification and early laparoscopic cholecystectomy are critical in the prevention of serious complications.

This document is currently not available here.

Share

COinS