Twisted Mystery: Identifying Gallbladder Volvulus: Challenges in Preoperative Diagnosis

BACKGROUND Gallbladder volvulus (GV) is a rare surgical emergency caused by the twisting of the gallbladder on its mesentery, leading to vascular compromise and potential necrosis. It primarily affects elderly women but can occur at any age or in either sex. Excessive gallbladder mobility is a key predisposing factor, and the condition often mimics acute cholecystitis, making early diagnosis challenging. Timely recognition is crucial to prevent severe complications. Given its rarity and frequent diagnostic uncertainty, each reported case provides valuable insight, and the present report contributes to the existing literature and serves as a practical example of how such uncommon conditions can be recognized and managed. CASE REPORT We report a case of an 85-year-old women with no significant medical history who presented with a 2-day history of severe right upper quadrant pain, nausea, and vomiting. Initial imaging (ultrasound and CT) was indicative but not typical of acute acalculous cholecystitis. Other differential diagnoses were considered and ruled out. Further review of the ultrasound and CT scans by a specialist radiologist raised suspicion of GV through some radiological pathognomonic signs (eg, the whirl sign). Laparoscopic view revealed a 360° gallbladder torsion, confirming the diagnosis of GV. Laparoscopic cholecystectomy was successfully performed without complications, and the patient had an uneventful recovery. CONCLUSIONS This case highlights the importance of considering GV in the differential diagnosis of abdominal pain in elderly patients. Increased awareness, a comprehensive clinical assessment, and advancements in radiological diagnostics are essential for early diagnosis and timely intervention.