# Gallbladder volvulus diagnosed by MRCP and diffusion-weighted imaging in an elderly woman

## TL;DR

An elderly woman with gallbladder volvulus was accurately diagnosed using MRCP and DWI, avoiding misdiagnosis and enabling timely surgery.

## Contribution

Demonstrates the diagnostic value of MRCP combined with DWI in confirming gallbladder volvulus when other imaging methods are inconclusive.

## Key findings

- MRCP and DWI identified gallbladder torsion and ischemia, confirming volvulus in an 84-year-old woman.
- Ultrasound and CT failed to definitively diagnose the condition despite suggestive findings.
- Laparoscopic surgery confirmed the MRCP/DWI diagnosis of 360° torsion with ischemia.

## Abstract

Gallbladder (GB) volvulus is a rare cause of acute abdominal pain and is frequently misdiagnosed as acute cholecystitis due to its nonspecific presentation. We report an elderly woman in whom magnetic resonance cholangiopancreatography (MRCP) with diffusion-weighted imaging (DWI) enabled a timely, accurate preoperative diagnosis. An 84-year-old woman presented with acute right upper quadrant pain; inflammatory markers were normal. Ultrasound (US) and contrast-enhanced computed tomography (CT) suggested acalculous cholecystitis; CT showed a “whirl sign” but no V-shaped distortion of the extrahepatic ducts. MRCP confirmed a “whirl sign” involving the cystic duct and artery, and DWI demonstrated diffusion restriction in the GB wall, consistent with acute ischemia secondary to torsion. Laparoscopic cholecystectomy confirmed a 360° torsion with ischemic changes. This case highlights the limitations of US and the variable sensitivity of CT for GB volvulus, especially in atypical presentations. MRCP with DWI provides complementary anatomic and functional information, supporting a confident preoperative diagnosis and prompt surgical intervention.