Gallbladder Volvulus: An Uncommon Twist in Biliary Pathology

Gallbladder volvulus (GBV) is an extremely rare disease, which presents similarly to acute cholecystitis. It has an incidence of less than 0.1% among urgent cholecystectomies and one in 356,000 hospital admissions. We report the case of a 92-year-old female with a three-day history of abdominal pain that had acutely worsened and localized to the right upper quadrant over the past 24 hours. Physical examination revealed a tender palpable mass in the right upper quadrant. Laboratory investigations demonstrated elevation of the white cell count and liver enzymes while CT abdomen showed a thick-walled gallbladder with an abrupt cut-off of the cystic duct suggestive of gallbladder volvulus. A laparoscopic cholecystectomy revealed a massively distended gangrenous gallbladder which has volved on the hepatocystic ligament. We present this case to demonstrate the radiological and intraoperative findings of GBV and to highlight the importance of early intervention to avoid life-threatening complications.