Andrew D Van Osdol, MD1, Brandon T Grover, DO2. 1Gundersen Medical Foundation, 2Gundersen Health System
Background: Gallbladder volvulus is a rare entity with an incidence of approximately 1 in 365,000 cases of gallbladder disease. A recent review of the literature resulted in approximately 500 cases of gallbladder volvulus being reported since it first appeared in the medical literature in 1898. It predominantly affects elderly women with a 4:1 female to male ratio, with the highest incidence in the 6th to 8th decades of life.
Case Summary: We present the case of an 88-year-old female who experienced sudden onset right sided abdominal pain 12 days after a segmental sigmoid resection for obstructing colon cancer. Imaging showed a distended and inflamed gallbladder which had previously been located in the left upper quadrant now in the right lower quadrant. She was taken to the operating room where laparoscopy revealed a large, necrotic gallbladder which was volvulized on a mobile mesenteric pedicle. After detorsion with 360 degree counterclockwise rotation, the triangle of Calot was identified, critical view obtained, and gallbladder removed laparoscopically.
Conclusions: An abnormal location of the gallbladder on preoperative imaging can suggest gallbladder volvulus but radiologic diagnosis can be difficult and intraoperative diagnosis is common. Consequently, a high level of suspicion should be maintained as this is a surgical emergency with a mortality rate of approximately 6%.