The floating gallbladder

Excerpt

The “floating gallbladder” was first described by Wendel [1] in 1898, describing an inferiorly displaced gallbladder with an unusually long cystic duct. The relevance of the floating gallbladder is to recognize its propensity to undergo torsion and perforation, a serious complication which can prove fatal [2]. The gallbladder is normally securely fixed to the liver by mesentery within the gallbladder fossa (Fig. 1). However, a congenitally long, incomplete, or atrophied mesentery grants the gallbladder enough mobility to migrate and twist about the cystic duct resulting in gallbladder torsion. Careful scrutiny of cross-sectional imaging will reveal an inferiorly and medially or laterally displaced gallbladder with twisting of the cystic duct (Fig. 2). Imaging may also reveal a dilated fluid-filled gallbladder with a thickened edematous wall, tantamount to acute cholecystitis [3]. Patients with torsion of the gallbladder are typically elderly females and will most often present clinically with colicky abdominal pain [2, 3]. Since gallstones may be absent, there may be a delay in the diagnosis of acute cholecystitis. Once detected, the floating gallbladder with associated torsion will require emergent surgical intervention; therefore timely diagnosis is key.

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