Gallbladder torsion in multimorbid older adults: a structured narrative review and case report

Gallbladder torsion (GT) is a rare, life-threatening surgical emergency that disproportionately affects older adults. Diagnosis is frequently complicated by multimorbidity and age-related anatomical changes, which mask typical symptoms and mimic acute cholecystitis. We report a complex case of GT and present a structured narrative review of 180 cases to provide evidence-based strategies for early recognition and surgical management.

We report the case of an 84-year-old male with sudden-onset severe right upper quadrant pain, nausea, and vomiting. Preoperative computed tomography revealed a markedly distended gallbladder with gallstones and pericholecystic fluid, and torsion was highly suspected but not definitively confirmed until laparoscopic exploration. Laparoscopic exploration confirmed 360° clockwise torsion of the gallbladder around the cystic duct and artery. Laparoscopic cholecystectomy was successfully performed, and the patient recovered uneventfully. Pathological examination confirmed transmural hemorrhagic necrosis and acute inflammation, consistent with gangrenous cholecystitis secondary to torsion.

GT is a critical differential diagnosis for acute abdomen in older adults. Age-related anatomical changes require a high index of suspicion, as clinical presentations often overlap with routine cholecystitis. Early recognition of specific imaging markers and immediate laparoscopic intervention are vital to prevent gangrene, perforation, and mortality in this vulnerable population.