title: A Clinician's Guide to the Diagnosis and Management of Gallbladder Volvulus.
abstract: BACKGROUND
  Gallbladder volvulus (GV), or torsion of the gallbladder, is an uncommon surgical emergency. This article reviews the world literature related to GV. We examine the history of gallbladder torsion and highlight the critical constellation of presenting signs and symptoms, which guide the acute care physician and surgeon to accurate and timely diagnosis of GV before surgical intervention.
  
  
  METHODS
  A comprehensive review of all published cases of GV was performed using the National Library of Medicine (PubMed) database.
  
  
  RESULTS
  Lists of typical symptoms and clinical presentations are provided to allow clinicians to establish an accurate preoperative diagnosis.
  
  
  CONCLUSIONS
  GV is frequently undiagnosed before surgical intervention. However, clinical presentation and associated radiographic findings can lead to an accurate diagnosis if the clinician is aware of this uncommon condition. When the diagnosis has been established before operative intervention, expeditious laparoscopic cholecystectomy can be performed safely. Delays in diagnosis may mandate open cholecystectomy if laparoscopic extraction is contraindicated because of undesirable sequelae of gallbladder necrosis, specifically perforation, bilious peritonitis, and hemodynamic instability.
authors.affiliation: Department of Graduate Medical Education, Exempla St Joseph Hospital in Denver, CO, USA. pottorfb@exempla.org
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Pottorf
authors.forename: Leonardo
authors.initials: L
authors.lastname: Alfaro
authors.forename: Harris W
authors.initials: HW
authors.lastname: Hollis
mesh_terms: D017081:Cholecystectomy, Laparoscopic; D003937:Diagnosis, Differential; D005704:Gallbladder / Q000002:abnormalities*; D005705:Gallbladder Diseases / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D017410:Practice Guidelines as Topic; D014102:Torsion Abnormality / Q000175:diagnosis* / Q000601:surgery