Gallbladder volvulus in an elderly patient presenting as acute calculous cholecystitis: a case report

Introduction and importance: Gallbladder volvulus is a rare, life-threatening emergency resulting from torsion of the gallbladder on its vascular pedicle. Its rarity and clinical similarity to acute cholecystitis make diagnosis difficult. This is the first documented case in the Philippines, highlighting its significance for local surgical practice. Presentation of case: A 74-year-old woman presented with acute right upper quadrant pain, nausea, vomiting, and bloating. Laboratory workup revealed leukocytosis with neutrophilia, and imaging suggested acute calculous cholecystitis. At surgery, complete 360° torsion of the gallbladder was confirmed. Cholecystectomy revealed a necrotic gallbladder with intraluminal stones. The patient recovered uneventfully and was discharged on postoperative day 3. Clinical discussion: Gallbladder volvulus is frequently misdiagnosed because of its nonspecific clinical, laboratory, and imaging features. Preoperative diagnosis is rarely achieved, with most cases confirmed intraoperatively. Prompt recognition and surgical intervention are crucial to prevent complications such as gangrene, perforation, and peritonitis. This report emphasizes the importance of considering gallbladder volvulus in elderly women with biliary symptoms not fully explained by imaging. Conclusion: Early suspicion, timely diagnosis, and urgent cholecystectomy are essential for favorable outcomes. This case highlights the need to increase clinical awareness of gallbladder volvulus in the Philippines to improve patient outcomes.