AB204. SOH26AB_0163. Case report of gallbladder torsion causing gangrenous cholecystitis: a rare surgical emergency

Background: Gallbladder torsion is an uncommon but potentially life-threatening cause of acute abdomen, often mimicking acute cholecystitis. Preoperative diagnosis is difficult, and delayed recognition may lead to gangrene or perforation. We present a case of complete gallbladder torsion identified intraoperatively in an elderly woman.

Case Description: A retrospective review of the clinical presentation, imaging findings, operative details, and postoperative course of a 71-year-old woman who presented with acute abdominal pain. The patient presented with sudden severe abdominal pain and vomiting, with tenderness in the right iliac fossa and hypogastrium. Inflammatory markers were elevated [white cell count (WCC) 19.9×10⁹/L]. Computed tomography (CT) abdomen-pelvis demonstrated a newly inflamed, distended gallbladder with hypo-enhancing walls concerning for gangrenous cholecystitis; a CT performed 5 days earlier was normal. Emergency laparoscopy revealed a markedly distended gallbladder, torted 360° clockwise on a long mesentery. The gallbladder was detorsed, and a difficult but safe laparoscopic cholecystectomy was completed due to altered anatomy and ductal dilatation. A postoperative magnetic resonance cholangio pancreaticography (MRCP) showed a normal cystic duct remnant and a mildly dilated common bile duct (CBD) (7.8 mm) without obstruction. Recovery was uneventful, and she was discharged on day 5.

Conclusions: Gallbladder torsion should be considered in elderly patients with abrupt severe right-sided abdominal pain and imaging that appears disproportionate to typical acute cholecystitis. Intraoperative diagnosis remains common. Prompt laparoscopic detorsion and cholecystectomy are essential and result in excellent outcomes.

Keywords: Gallbladder torsion; gallbladder volvulus; laparoscopic cholecystectomy; common bile duct (CBD); case report