# A Rare Surgical Case of Gallbladder Volvulus Masquerading as Acute Cholecystitis

## TL;DR

This paper presents a rare case of gallbladder volvulus mistaken for cholecystitis, emphasizing the need for early diagnosis and surgical intervention to prevent severe complications.

## Contribution

The paper contributes a detailed clinical case highlighting diagnostic challenges and management of gallbladder volvulus in elderly patients.

## Key findings

- Gallbladder volvulus can mimic acute cholecystitis, leading to diagnostic difficulties.
- Laparoscopic cholecystectomy is effective for treating gallbladder volvulus when diagnosed early.
- Early intervention prevents complications like necrosis and biliary peritonitis.

## Abstract

Gallbladder volvulus (GBV) is a rare and life-threatening condition characterized by the twisting of the gallbladder on its pedicle, resulting in obstruction of the cystic duct, artery, and vein. This leads to compromised blood flow, ischemia, and potentially severe complications, including necrosis or perforation. Although GBV shares clinical symptoms with acute cholecystitis, it requires urgent surgical intervention due to its rapid progression and severe consequences if left untreated. GBV predominantly affects elderly females and is often associated with anatomical variations that allow for increased mobility of the gallbladder, contributing to its torsion. An 84-year-old female presented with 24 hours of severe, diffuse abdominal pain, nausea, and vomiting. Initial imaging suggested cholecystitis, prompting the placement of a percutaneous cholecystostomy tube. However, laparoscopic cholecystectomy revealed a torsed, hyperemic gallbladder with signs of ischemia, though no perforation was noted. The gallbladder was detorsed, and the cystic duct and artery were divided. The patient recovered uneventfully and was discharged on postoperative day one.

GBV often presents with clinical features similar to acute cholecystitis, complicating diagnosis. Imaging, including ultrasonography and CT scans, may reveal thickened gallbladder walls and pericholecystic fluid, but the absence of gallstones and identification of atypical anatomical positioning can raise suspicion for GBV. Surgical treatment, particularly laparoscopic cholecystectomy, remains the gold standard for management. Early recognition and intervention are crucial to prevent gallbladder necrosis, perforation, and biliary peritonitis. This case underscores the importance of heightened clinical suspicion and timely intervention to reduce morbidity and mortality associated with GBV. GBV is a rare but serious cause of acute abdominal pain, particularly in elderly patients. This case highlights the diagnostic challenges and the critical role of early intervention in preventing severe complications. Accurate imaging and surgical treatment are essential for successful outcomes.