The deceitful diagnosis of gallbladder volvulus: A case report

Acute gallbladder pathologies beyond uncomplicated cholecystitis

The gallbladder can be affected by various acute conditions beyond uncomplicated cholecystitis, with the prevalence of gallstones having risen over the past three decades. Management of biliary diseases is complex and necessitates careful case-by-case consideration. Radiologic imaging plays a crucial role in the evaluation, diagnosis, and management planning of biliary pathologies. This review explores acute gallbladder conditions such as simple cholecystitis, gangrenous cholecystitis, emphysematous cholecystitis, hemorrhagic cholecystitis, perforated cholecystitis, gallbladder fistulas, gallstone ileus, Bouveret syndrome, Mirizzi syndrome, gallbladder herniation, volvulus, trauma, pseudoaneurysm, portal venous thrombosis, and gallbladder carcinoma. It highlights the utility of various imaging modalities including ultrasound, CT, dual-energy CT, MRI, and MRCP in diagnosing these conditions. Advancements in imaging techniques have enhanced the ability to detect and characterize gallbladder diseases, facilitating timely surgical interventions and improving patient outcomes. This review emphasizes the importance of close collaboration between radiologists and clinicians to optimize diagnosis and management strategies, underscoring the indispensable role of radiologic imaging in modern medicine.

Gallbladder Volvulus in an Elderly Female With Severe Kyphoscoliosis

Gallbladder volvulus is a very rare complication of a congenital defect in gallbladder development also known as a "floating" gallbladder and often presents in the elderly. Proposed aetiologies include loss of abdominal fat and kyphoscoliosis. We present a patient with severe lumbar scoliosis centred on L2, producing a lumbar vertebral distortion of about 30 degrees concave to the right, resulting in right hemiabdomen volume loss. The mechanical interaction between the gallbladder fundus and compressed viscera transmits abnormal ambulatory forces from the distorted right pelvic brim into the abdomen predisposing to gallbladder torsion. Laparoscopic cholecystectomy was performed without complication and the patient had an uneventful recovery. This case demonstrates the challenges of diagnosing gallbladder torsion preoperatively. A high level of clinical suspicion is vital especially in elderly patients to enable timely surgical intervention to reduce morbidity and mortality.

Hybrid Single-Port Cholecystectomy of a Pediatric Gallbladder Volvulus

Gallbladder volvulus is a rare gallbladder pathology that can present in adults but is exceedingly rare in children. The diagnosis itself can be very challenging due to its presentation with signs and symptoms of acute cholecystitis without specific imaging findings. The correct identification and prompt intervention with a cholecystectomy are crucial to improve patient outcomes. In this report, we discuss a pediatric patient who presented with gallbladder volvulus and subsequently underwent novel treatment with a single-port laparoscopic cholecystectomy. The patient is a 12-year-old male of Haitian descent who presented to an outside facility following the onset of persistent, right upper quadrant abdominal pain and recurrent nonbilious emesis. The diagnostic workup included serial abdominal exams, laboratory work, right upper quadrant ultrasounds, and a hepatobiliary iminodiacetic acid (HIDA) scan. The patient then underwent single-port laparoscopic removal of the torsed gallbladder with complete resolution of his symptoms. In this case report, the management and clinical presentation of gallbladder volvulus are discussed in more detail as well as the feasibility of single-port laparoscopic cholecystectomy in the setting of pediatric gallbladder volvulus.

Gallbladder Volvulus: A Review

Gallbladder volvulus is an uncommon condition that mostly affects older women. The cause of gallbladder volvulus is unknown, although intraoperative evidence of a floating gallbladder with a twisting of its pedicle, resulting in gallbladder ischemia, may lead to subsequent complications. Gallbladder volvulus symptoms are similar to acute cholecystitis, leading to delayed diagnosis and treatment. Early detection and prompt surgical intervention are critical for reducing morbidity and mortality. Even though numerous case reports have been published since 1898, gallbladder volvulus remains challenging to diagnose preoperatively. As a result, a high level of suspicion is required to prompt cholecystectomy and avoid further complications. We review the etiology, pathophysiology, clinical manifestation, diagnostic strategies, and treatment of this disease.