What is Twisted Gallbladder?
Gallbladder torsion or twisting is one rarely known health condition, which is primarily seen in elderly women, but younger adults and even children may fall victim to it. Gallbladder torsion or a twisted gallbladder can be a very painful and a serious condition, requiring immediate medical attention. It is essential to know the symptoms of twisted gallbladder, its causes, diagnosis and treatment.
Gallbladder is that organ of the body, known to stock up the bile, which is produced by the liver. Gallbladder is positioned beneath the liver and it pours bile into the small intestine through the bile duct. Gall bladder is known to have its own duct, neck, the duct however is identified as cystic duct, and this duct is connected to the bile duct. We are aware of varying gallbladder conditions such as gallbladder inflammation (cholecystitis), gallstones (cholelithiasis), but there are other conditions too, which can affect the gallbladder. Twisted gallbladder, although rare, can be a serious medical emergency and knowing the symptoms of twisted gallbladder can help to provide timely treatment.
Symptoms of Twisted Gallbladder
Twisted gallbladder, also known as gallbladder volvulus or gallbladder torsion, is a condition when the gallbladder loses its tenacity and gets twisted. In such a condition, blood flow is greatly obstructed and gall bladder tissues are deprived of sufficient oxygen supply and other essential nutrients. This is often an emergency, which cannot be treated with medicine, so surgery is fundamental and one single solution to resolve the problem of twisted gallbladder.
However early prevention is needed or else the condition of twisted gallbladder may end in fatality. Regrettably, twisted gallbladder or gallbladder torsion is often not paid attention and the symptoms are not hugely different from other gallbladder related problems, so people usually think that they must be suffering through all those traditional gallbladder disorders.
Twisted gallbladder is a rare condition and can affect those who are physically frail and vulnerable. Women are the worst victim, today longer life expectancy is deemed to be triggering gallbladder torsion. With growing age, supporting tissues undergo number of changes, and the risk of twisted gallbladder may increase, in some people.
Twisted gallbladder may occur as incomplete or complete. Complete torsion is twisting of gallbladder to 180 degree but when the torsion is not 180 degree it is identified as incomplete gallbladder torsion. In completely twisted gallbladder, the situation turns serious due to occlusion of blood vessels, resulting in inadequate blood supply. If treatment is not initiated in due time then there could be the case of gangrene, which is certainly life threatening. Hence, it is important to be aware of the symptoms of twisted gallbladder.
The worst thing is, there is no specification regarding the symptoms of twisted gallbladder or gallbladder torsion. However survey confirms that there are few signs and symptoms experienced by most patients of twisted gallbladder. These include
- Excruciating abdominal pain
- Nausea and vomiting
- Feeling of an abdominal mass
- Fever, sweating and changes in pulse.
Symptoms of twisted gallbladder often vary from one patient to another. Some patients experience different abdominal conditions, such as acute pancreatitis and gallstones. When it is an incomplete twisted gallbladder, symptoms may come up one after another but when in complete twisted gallbladder, things may worsen faster. In such conditions one may require medical attention as early as possible.
Causes of Twisted Gallbladder
As a person ages, the ligaments and tissues, lose their firmness and begin to slack. There is also the loss of visceral fat which is essential for supporting abdominal organs. The commonest causes of twisted gallbladder include the loss of surrounding support and the lack of firmness, which cause the gallbladder to hang, losing its normal posture. The situation is known as floating gallbladder. When the gallbladder hangs, it may twist resulting in a twisted gallbladder.
Some of the common triggers causing twisted gallbladder include
- When there is strong peristaltic movement or when the stomach contracts, intestine may turn and curl the gallbladder.
- When people have a spinal irregularity known are kyphoscoliosis, gall bladder may twist.
- When there is noticeable abnormality in gallbladder mesentery, where blood vessels are present and carry blood to intestine, twisting may occur. Mesentery is responsible for supplying blood to gallbladder when the mesentery loses its attachment with liver, it can cause twisted gallbladder.
- Gall stone is another commonest cause of twisted gallbladder.
Diagnosis of Twisted Gallbladder
As the symptoms of twisted gallbladder are similar to other conditions of gallbladder, it is quite challenge to diagnose the problem. It is seen that approximately only 10% patients are found to have twisted gall bladder pre-operatively. In most cases the diagnosis of twisted gallbladder is done during laparotomy surgical procedure.
Some investigations for the diagnosis of twisted gallbladder include
- Abdominal ultrasound or CT (computed tomography scan).
- Specialized tests like hepatoiminodiacetic acid scan and MRCP or magnetic resonance cholangiopancreatography are helpful enough in deciding whether the patient is having twisted gallbladder or not.
- Blood tests may show an increase in white blood cell if the blood supply is hindered and of course when gangrene starts.
Diagnosis of twisted gallbladder is done with exploratory surgery in many patients. Gall bladder is removed surgically in laparotomy, where firstly the torsion is undone and bile duct is protected and lastly the gall bladder is removed. If the gall bladder is left untreated, it can again result in a twisted gallbladder.
Treatment of Twisted Gallbladder
With medicine the situation cannot be tended, surgery is the only alternative to opt for in treating twisted gallbladder. However laparoscopic surgery is deemed best but for some cases open surgery may be needed to treat twisted gallbladder. Removing the gallbladder is the best solution. Undoing the twisting does not help much as the same situation may occur again in future, hence gallbladder has to be removed.
Early diagnosis of twisted gallbladder or recognizing the symptoms of twisted gallbladder is better, to avoid complications. Timely treatment is essential as the condition can rapidly worsen I case of elderly patients and appropriate treatment of twisted gallbladder can prevent fatal outcomes. Most cases of surgical treatment of twisted gallbladder have been successful without any complications.
- Journal of Radiology Case Reports – Gallbladder Torsion: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542946/
- Medicine (Baltimore) – Gallbladder Torsion: A Systematic Review: https://pubmed.ncbi.nlm.nih.gov/27100437/
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