Fact-sheet: Gallbladder volvulus
Updated on 04/23/2019 at 9:48 AM
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Definition
Gallbladder mobility, with torsion of the cystic duct and vascular pedicle resulting in gallbladder ischemia.
Clinical features
- population: elderly, thin woman.
- clinical: sudden right upper quadrant pain, clinical suspicion of acute-on-acute cholecystitis, sometimes with palpation of a tender right upper quadrant mass.
Laboratory findings
Not very informative.
No inflammatory syndrome initially.
Radiography
Not contributory.
Ultrasound
- distended gallbladder, in an unusual prehepatic position, with the gallbladder fundus in a caudal position.
- sonographic Murphy sign often present
- external location of the gallbladder neck / whirl of the pedicle.
- Contrast-enhanced ultrasound: absence of wall enhancement.
CT
- distended gallbladder.
- potentially spontaneously hyperdense, hemorrhagic content.
- neck in an external position, "whirl sign" of the cystic pedicle.
- lack of gallbladder wall enhancement.
- infiltration of the pericholecystic fat.
- look for secondary perforation.
MRI
not urgent.
Vascular intervention
no
Differential diagnosis
- acute cholecystitis