Background:
Gallbladder volvulus is a rare but potentially life-threatening condition caused by torsion of the gallbladder on its mesentery, leading to compromised vascular supply and biliary obstruction. Its clinical and radiological features are often non-specific, making pre-operative diagnosis challenging. Prompt surgical intervention is essential to prevent necrosis, perforation, and sepsis. Awareness of patient risk factors—such as advanced age, female sex, spinal deformities, and loss of visceral fat—is important for early recognition.
Case Presentation:
A 77-year-old female presented with sudden-onset severe epigastric pain radiating to the back, accompanied by nausea, vomiting, and anorexia. The pain was persistent and unresponsive to analgesia. Her history included gastro-oesophageal reflux disease, chronic kidney disease stage 3, hiatus hernia, and spinal stenosis, though she remained functionally independent.
Laboratory investigations were largely unremarkable, with only a mildly elevated alkaline phosphatase. Differential diagnoses included acute cholecystitis and gastric volvulus. Computed tomography revealed a distended gallbladder in an abnormal position between the diaphragm and liver segment VIII. Magnetic resonance cholangiopancreatography further demonstrated displacement of the gallbladder with a possible twisted cystic pedicle, highlighting the importance of careful imaging review in atypical presentations.
She underwent emergency laparoscopic cholecystectomy. Intra-operatively, the gallbladder was located above the liver dome with torsion of the cystic duct and artery, confirming volvulus. She made an uneventful recovery and was discharged on postoperative day four with outpatient follow-up.
Conclusion:
This case underscores the diagnostic challenges of gallbladder volvulus and the importance of maintaining a high index of suspicion in elderly patients with acute abdomen. Early recognition, attention to imaging clues, and prompt surgical intervention are critical to achieving favourable outcomes.
