Volvulus is twisting of a non solid organ around its mesentric axis. Gallbladder volvulus is twisting or rotation of the gallbladder along the axis of the cystic duct and vascular pedicle (cystic artery).^[1]

It was first described by Wendal in 1898.

Torsion of gall bladder leads to occlusion of the cystic duct and the cystic artery. This torsion can be complete (180^o – 360^o) or incomplete (< 180^o). Incomplete torsion causes obstruction of the bile duct and vascular supply may be spared. In complete obstruction both are compromised. This occlusion leads to an increased amount of bile in the lumen and a decreased flow of blood to the organ. Increased pressure in the lumen with ischemia leads to acute inflammation causing a surgical emergency.

Presentation of gallbladder volvulus is very non -specific. It is tough to diagnose based upon just the history and symptoms because patients present with acute abdominal pain with or without vomiting. At times there may be a tender mobile mass palpated suggestive of a floating gallbladder.

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It was first described by Wendal in 1898.

Torsion of gall bladder leads to occlusion of the cystic duct and the cystic artery. This torsion can be complete (180^o – 360^o) or incomplete (< 180^o). Incomplete torsion causes obstruction of the bile duct and vascular supply may be spared. In complete obstruction both are compromised. This occlusion leads to an increased amount of bile in the lumen and a decreased flow of blood to the organ. Increased pressure in the lumen with ischemia leads to acute inflammation causing a surgical emergency.

• Enlarged and distended gallbladder.
• Torsion along the long axis of the peduncle.
• Thick edematous wall with mucosal congestion.

• Extensive necrosis of the wall.^[1]
• Findings may be similar to gangrenous cholecystitis due to severe ischemia.
• The GB wall shows almost complete coagulation necrosis with intramural hemorrhages.
• A thin layer of degenerated collagen fiber, derived from the mucosa and proper muscle, may be seen along the inner side, and a thin subserosal connective tissue layer may seen along the outermost side.

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Volvulus of gallbladder is known to be caused due to:^[1]

• Inherent causes
  • Floating gallbladder
• Acquired causes
  • Splanchnoptosis
  • Senile humpback
• Physical causes
  • Sudden changes of intraperitoneal pressure
  • Sudden changes of body position
  • Hyperperistalsis of organs near the gallbladder
  • Trauma to the abdomen

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• Careful evaluation is important to rule out other causes of jaundice that argue against the diagnosis.
  • Absence of toxemia
  • Poor response to antibiotic therapy
  • Ultrasound or other imaging studies help in differentiating gallbladder volvulus from other causes.

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Over 500 cases have been documented since its description in 1898.^[1]

• There are very few cases reported in the pediatric population.
• 85% of the cases are reported in 60 – 80 age group.

• There is a female preponderance for this condition.^[2]
• Female to male ratio is 3:1.^[3]

Risk factors for gallbladder volvulus include^[1]:

• Constipation
• Hyperperistalsis
• Multiparity
• Scoliosis
• Weight loss

The role of cholelithiasis as a risk factor is uncertain.

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• Acute perforation
• Bilious peritonitis
• Bowel adhesion
• Gallbladder necrosis
• Gangrenous cholecystitis
• Sepsis

• It has a favorable prognosis due to early diagnosis and prompt treatment.
• With immediate surgery the mortality rate is less than 5%.^[1][2]