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Back to 2014 Annual Meeting Posters Gallbladder Volvulus: a Single Institution's Experience Over Two Years Zach Deboard*, Pam Lee, James Dunn, Lisa Ferrigno, DAVE Thoman, Marc Zerey Santa Barbara Cottage Hospital, Santa Barbara, CA Introduction: Gallbladder volvulus is a rare and acute surgical disorder with roughly five hundred cases reported. Pre-operative workup can be misleading and may be suggestive of cholecystitis. Objective: To characterize patients with gallbladder volvulus and compare to those in prior reports to determine unique pre-operative findings to aid in diagnosis. Methods: A retrospective review of all cases of gallbladder volvulus from 2011-2013. Findings: Five patients were identified. All were slender, elderly, had a medical history significant for coronary disease, complained of nausea, denied fevers and chills, and had variable characterization of their pain. One patient had a Murphy's sign. All patients had markedly distended gallbladders, often outside the gallbladder fossa. Two patients had a whirl sign on CT, suggesting the diagnosis of volvulus. Gallbladder sizes were similar amongst imaged and pathologic measurements and 2 had stones. Those with longer time to presentation had higher leukocyte counts and gallbladder necrosis. Only one patient had an elevation in liver function laboratory values. All patients were treated via urgent laparoscopic cholecystectomy and had unremarkable postoperative courses. Conclusion: Gallbladder volvulus remains an uncommon urgent surgical condition. Typical features to the current and prior reports include old age, thin habitus, and varied clinical examinations. Additionally, radiographic findings are consistent: marked gallbladder enlargement and wall thickening with torsion present on higher-fidelity imaging. This is the largest single-center analysis in the United States and offers findings suggestive of gallbladder volvulus as a pre-operative diagnosis. Volvulus may be suggested by the lack of fever, Murphy's sign, and leukocytosis in the setting of epigastric pain. Radiographically, a markedly distended, thick-walled gallbladder on imaging may support the diagnosis but additional findings of a very large gallbladder out of its fossa and / or a whirl sign are more specific. Stones remain an inconsistent finding with volvulus. Given an aging population, a paucity of consistent history and exam findings and potentially confusing ultrasound findings, misdiagnoses are possible, thus imaging with CT may be of benefit. Urgent laparoscopic cholecystectomy continues as the mainstay of therapy. Patient and Radiographic Characteristics
 Axial CT slice demonstrating "whirl" sign suggesting volvulus. Back to 2014 Annual Meeting Posters |
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