Two cases of gallbladder torsion presenting with right lower quadrant pain: Clinical and imaging characteristics

Gallbladder torsion (GT) is a rare cause of acute abdominal pain. Due to its rarity and nonspecific clinical presentation, GT is frequently misdiagnosed preoperatively. We report 2 cases of GT in patients initially suspected of acute appendicitis, both presenting with right lower abdominal pain. We conducted a retrospective analysis of the clinical and radiological findings in these 2 patients to enhance our understanding of and management for this condition.

Case 1 was a thin 80-year-old woman who was admitted to the hospital with migration of pain to the right lower quadrant, persisting for 3 days. Case 2 was a thin 84-year-old woman who was admitted to the hospital with right-sided abdominal pain that had persisted for over 20 hours.

Emergency abdominal ultrasound examination revealed a low-lying gallbladder in case 2 and an enlarged gallbladder with a small amount of perigallbladder fluid collection in both patients. Non-contrast computed tomography revealed an enlarged gallbladder with disrupted gallbladder mucosa in both cases. In addition, the first case exhibited a whirlpool structure in the cystic duct region, alongside a pedicled hyperdense structure located between the neck of the gallbladder and the liver bed. In the second case, a strip-like structure was observed within the cystic duct area. Postoperative pathology confirmed acute gangrenous cholecystitis in both patients' gallbladders and acute simple appendicitis in their appendices.

Both patients underwent laparoscopic cholecystectomy.

Both patients recovered well and were discharged within 1 week.

GT presenting with appendicitis-like symptoms is relatively uncommon. For thin elderly female patients presenting with signs related to appendicitis, the possibility of GT should be considered. Non-contrast computed tomography is valuable for diagnosing GT.