Challenges In The Diagnosis Of Gallbladder Volvulus
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.