Surgical management of gallbladder volvulus

An elderly female in her 80s presented to the Emergency Department with abdominal pain and vomiting, following episodes of intermittent colicky abdominal pain over the preceding 3 days. On examination she was exquisitely tender over a palpable gallbladder in the mid epigastric region. The patient underwent cross-sectional imaging suggestive of acute acalculous cholecystitis and significant hydrops with possible perforation. On review of the images, a suspicion of gallbladder volvulus resulted in emergency need for intervention. At laparoscopy, a diagnosis of gallbladder volvulus was confirmed, with a grossly distended, necrotic gallbladder noted on entry into the abdomen. The gallbladder was detorted and returned to the anatomical position, after which a routine laparoscopic cholecystectomy was performed. This case highlights the need to retain a high index of suspicion for gallbladder volvulus especially in elderly patients, without known gallstones, with a history of colicky pain and imaging features suggestive of torsion.