# Unexpected Intraoperative Discovery of Gallbladder Volvulus in an Elderly Female: A Case Report

## TL;DR

A rare case of gallbladder volvulus was discovered during surgery in an elderly woman, highlighting the difficulty in diagnosing this condition.

## Contribution

This case report adds to the limited literature on gallbladder volvulus and emphasizes the need for improved diagnostic strategies.

## Key findings

- Gallbladder volvulus was diagnosed intraoperatively despite initial imaging suggesting acute cholecystitis.
- The patient recovered well after timely cholecystectomy.
- Imaging modalities like ultrasound and CT have limited sensitivity for diagnosing gallbladder volvulus.

## Abstract

Gallbladder volvulus is a rare but potentially life-threatening condition that can closely mimic the clinical presentation of acute cholecystitis. It occurs when the gallbladder twists on its axis, potentially causing obstruction, ischemia, and necrosis. Early diagnosis and surgical intervention are crucial in preventing complications. An 81-year-old female presented to the emergency department with nausea, epigastric pain, and right upper quadrant (RUQ) abdominal pain. Physical examination revealed tenderness in the epigastric region and RUQ, a positive Murphy’s sign, and guarding in the RUQ. Laboratory testing demonstrated leukocytosis, and a computed tomography (CT) scan with intravenous (IV) contrast identified pericholecystic fluid, gallbladder wall thickening, surrounding inflammation, and a gallstone obstructing the gallbladder neck, leading to an initial diagnosis of acute calculous cholecystitis. Intraoperative findings revealed a gallbladder volvulus. A timely cholecystectomy was performed, and the patient recovered without significant postoperative complications. Gallbladder volvulus presents a diagnostic challenge due to its nonspecific symptoms, which can mimic those of biliary pathologies. Imaging modalities like ultrasound and CT have limited sensitivity, while magnetic resonance cholangiopancreatography or color Doppler sonography have shown promise in improving diagnosis. Early recognition and surgical intervention are essential to avoid severe outcomes. This case highlights the diagnostic challenges posed by gallbladder volvulus. Further research is needed to explore optimal diagnostic strategies for preventing poor clinical outcomes in patients with gallbladder volvulus.