GALLBLADDER TORSION

ETIOLOGY:-

GV, or torsion of the gallbladder, rarely occurs when the gallbladder twists around its mesentery. Contributory factors for this to occur are postulated to be an associated anatomical abnormality of the vascular pedicle to the gallbladder or the presence of an abnormally long mesentery from the gallbladder to the liver bed allowing it to float freely. The gallbladder, in this situation, can twist around the axis of the cystic duct and artery. During the process of aging, there is a loss of visceral fat attributed to the higher incidence of gallbladder volvulus in the older age group. The other contributing factors for the development of this condition are the peristaltic activity of the surrounding bowel, spinal deformities, and tortuous atherosclerotic cystic artery.

EPIDEMIOLOGY:-

Gallbladder volvulus has been reported in many age groups; however, it is most common in the elderly. It commonly affects women in their seventies and eighties. The occurrence in women is higher compared to men at a ratio of 3:1. Mortality associated with this is seen.

PATHOPHYSIOLOGY:-

Gallbladder torsion is now recognized as an acute condition which occurs when the gallbladder twists on its elongated mesentery along the axis of the cystic duct and artery. The presence of gallstones is neither a prerequisite nor thought to contribute to this condition which results from organoaxial-rotation. The resultant pathological consequences in the gallbladder are compromised blood supply resulting in ischemia and necrosis as well obstruction to biliary drainage. The gallbladder becomes more predisposed to hang free and undergo torsion with aging. The torsion can present as either complete or incomplete. When the rotation is more than 180 degrees, it is considered to be complete, but, if the rotation is less than 180 degrees, then it is considered incomplete.