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Gallbladder volvulus diagnosed intraoperatively: Case report
Omar Tabbikha1, Daniel El Israwi1, Hussein Yehya1
1Department of General Surgery, Mount Lebanon Hospital University Medical Center, Faculty of Medicine and Medical Sciences at University of Balamand, Lebanon, Beirut.
Insights
Gallbladder volvulus, a rare surgical emergency, can mimic common gallbladder issues. Urgent surgery is vital for this condition, which may be diagnosed intraoperatively when typical symptoms are absent.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Gallbladder volvulus is a rare condition with overlapping symptoms to calculous cholecystitis.
- Early diagnosis and urgent surgical intervention (cholecystectomy) are critical due to high morbidity and mortality rates.
Introduction:
Gallbladder volvulus is a rare disease whose presentation usually overlaps with that of typical calculous cholecystitis. It's diagnosis is critical as it is associated with high morbidity and mortality and therefore should be managed urgently with cholecystectomy.
Case Presentation:
85-year-old female patient presented with right upper quadrant pain of one day duration that is associated with nausea and vomiting, but no fever or jaundice. She was tachycardiac and had severe abdominal right upper quadrant tenderness with positive Murphy's sign. Laboratory results showed only increase in inflammatory markers. Both ultrasound and computed tomography scan of the abdomen were done and acalculous cholecystitis was diagnosed. Open cholecystectomy was planned and performed, but gallbladder volvulus as the cause of cholecystitis was noted intraoperatively.
Discussion:
There is still no consensus on the exact cause of gallbladder volvulus. Even though it presents mostly in elderly patients, different ages have been already reported. It's diagnosis can be suspected based on the appearance, symptoms, and examination of the patient. Laboratory tests and imaging might provide some clues for it's diagnoses. It's ischemic process prompts urgent surgical intervention and does not improve conservatively. Our patient did not present with all of it's typical symptoms and the diagnosis was made intraoperatively.
Conclusion:
Gallbladder volvulus could have been missed had we not opt for an urgent surgery. More studies should be done to further define its presentation, and accurately know when to consider it up in our differential diagnosis.
