# Gallbladder Volvulus: A Great Mimicker of Acute Cholecystitis

## TL;DR

Gallbladder volvulus is a rare condition often mistaken for acute cholecystitis, requiring urgent surgery for treatment.

## Contribution

This case highlights the diagnostic challenges and importance of recognizing gallbladder volvulus in elderly patients.

## Key findings

- Gallbladder volvulus was confirmed intraoperatively after initial misdiagnosis as biliary colic.
- Early recognition through imaging and clinical suspicion can improve patient outcomes.
- The condition should be considered in elderly patients with atypical presentations of acute cholecystitis.

## Abstract

Gallbladder volvulus is a rare disease process, with approximately 500 reported cases in the current literature. Preoperative diagnosis is challenging, with only about 80 cases reported as being diagnosed prior to surgery, as it is frequently misdiagnosed as acute cholecystitis. Prompt recognition is vital, as the mainstay of treatment is emergent surgical intervention.

This case describes an 84-year-old female who presented with right upper quadrant abdominal pain. Initial computed tomography (CT) demonstrated biliary anatomic abnormalities with relatively unremarkable laboratory values, and a presumptive diagnosis of biliary colic was made, concerning for the development of acute cholecystitis. The patient was discharged with plans for an outpatient ultrasound and follow-up, but returned the following day with worsening symptoms. Repeat imaging demonstrated gallbladder wall thickening without cholelithiasis. Laparoscopic cholecystectomy was performed, and intraoperative findings confirmed gallbladder volvulus. The patient had an uneventful postoperative course.

Early recognition of gallbladder volvulus may improve outcomes and prevent complications. Characteristic imaging findings and atypical clinical presentations should raise suspicion for gallbladder volvulus and prompt further investigation. Although rare, gallbladder volvulus should be considered in the differential diagnosis of pediatric and elderly female patients presenting with symptoms similar to acute cholecystitis.