Gallbladder Volvulus Presenting as Acute Cholecystitis: Diagnostic Challenges and the Need for Early Surgical Intervention

Gallbladder volvulus, or “floating gallbladder,” is a rare but serious and potentially life-threatening condition that is frequently overlooked for more common biliary pathologies. Preoperative diagnosis can be challenging given a similar clinical presentation to the more common acute cholecystitis, and a high index of suspicion for gallbladder volvulus is required for prompt diagnosis. Unlike cholecystitis, patients with gallbladder volvulus cannot and should not be managed nonoperatively, and failure of conservative therapy in suspected cholecystitis should prompt consideration for an unconventional diagnosis such as torsion. Timely surgical treatment avoids the complications and morbidity of delayed cholecystectomy and leads to overall improved patient outcomes. We report a case of gallbladder volvulus in an elderly patient presenting with signs and symptoms mimicking acute cholecystitis. The patient was admitted for laparoscopy and intraoperatively found to have twisting of the cystic pedicle causing gallbladder ischemia. Given the increased incidence of gallbladder volvulus in the geriatric population, the more liberal use of alternative imaging modalities such as magnetic resonance cholangiopancreatography (MRCP) may be warranted moving forward. Importantly, early surgical intervention is key to successful management of gallbladder volvulus.