132 When the Gallbladder Turns on Itself: A Rare Case of Gallbladder Volvulus

Abstract Gallbladder volvulus is a rare but potentially life-threatening condition, characterised by torsion of the gallbladder on its mesentery, compromising vascular supply and biliary drainage. Diagnosis is challenging due to non-specific clinical and radiological features. Prompt surgical intervention is crucial for a favourable outcome. We present a case of gallbladder volvulus presenting as an acute abdomen, successfully managed as a surgical emergency. The case also briefly reviews risk factors, pathophysiology, and diagnostic strategies for this unusual condition. A 77-year-old female presented with sudden-onset severe epigastric pain radiating to the back, associated with nausea, vomiting, and anorexia. The pain was unremitting and unresponsive to analgesia. Her comorbidities included GORD, CKD stage 3, hiatus hernia, and spinal stenosis. She was functionally independent and, despite these conditions, deemed a suitable surgical candidate. Initial blood tests were largely unremarkable, apart from a mildly elevated alkaline phosphatase. Initial differentials included acute cholecystitis and gastric volvulus. CT imaging demonstrated a distended gallbladder in an abnormal position between the diaphragm and liver segment VIII. MRCP confirmed displacement of the gallbladder with a possible twisted cystic pedicle. 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 recovered well and was discharged on postoperative day four with routine follow-up. This case highlights the diagnostic challenges posed by gallbladder volvulus and reinforces the need for early recognition. We also review cases reported in the literature since its first description by Wendel in 1898.