An unusual presentation of acute cholecystitis: gallbladder volvulus

Gallbladder volvulus is a rare condition with similar presentation to acute cholecystitis. It is caused by the gallbladder twisting upon its mesentery leading to potential ischemia and biliary obstruction. A 77-year-old female presented with symptoms of right upper quadrant pain and nausea. She was found to have an elevated leukocytosis and a palpable right upper quadrant abdominal mass on exam. Imaging revealed a severely distended gallbladder with pericholecystic fluid and wall thickening without gallstones. Intraoperatively, an extremely distended, ischemic gallbladder was noted to have twisted upon its mesentery. The structures were able to be identified and the gallbladder was able to be safely removed with a laparoscopic approach despite its large size. Gallbladder volvulus is important to consider in the differential of acute cholecystitis because delay in intervention could lead to gallbladder necrosis and possible perforation, increasing the patient's morbidity and mortality.