Emergency laparoscopic cholecystectomy for gall bladder volvulus presenting as acute abdomen in an octogenarian: A case report

Gall bladder volvulus (GBV) is a rare surgical emergency characterised by torsion of the gall bladder on its mesentery, leading to potentially life-threatening consequences. The presentation of this condition often resembles that of typical calculous cholecystitis, requiringW a high level of clinical suspicion to diagnose and treat it promptly. It is essential to comprehend the clinical subtleties of GBV due to its infrequency and difficulties in diagnosis to prevent serious consequences. We present the case of an 86-year-old frail woman who presented to the emergency department with sudden-onset vomiting and acute abdominal pain. Imaging revealed a distended gall bladder with massive wall thickening and biliary tree dilation, suggestive of biliary obstruction due to gall bladder torsion. Emergent laparoscopic cholecystectomy was performed, revealing a torsed gall bladder with gangrene and intramural haemorrhage. Post-operative management included antibiotics, and the patient experienced an uneventful recovery. This case emphasises the need to consider GBV as a differential diagnosis for elderly patients experiencing acute abdominal symptoms. Advanced imaging modalities, such as magnetic resonance imaging, play an important role in detecting GBV preoperatively and aiding treatment planning. Surgical intervention remains the cornerstone of GBV treatment, necessitating precise surgical techniques to avoid complications. The rarity of GBV and its similarity to acute cholecystitis makes it difficult to diagnose. This case emphasises the significance of maintaining a high index of suspicion for GBV, especially in frail elderly patients.