Gallbladder torsion presenting as acalculous cholecystitis: a case report and review of management in a high-risk elderly patient
Thawatchai TrimitwittayakullIntroduction and importance:
Gallbladder torsion is a rare surgical emergency that predominantly affects elderly, thin women. Its clinical and radiological presentation often mimics acute acalculous cholecystitis, making preoperative diagnosis challenging.
Case presentation:
We report the case of a 94-year-old Thai woman who presented with acute right-sided abdominal pain. Initial ultrasonography and computed tomography suggested acute acalculous cholecystitis. Initial treatment included intravenous fluids, antibiotics, analgesia, and close clinical monitoring. Because immediate laparoscopic surgery was not feasible owing to operating-room and staffing constraints during a holiday period amid the COVID-19 pandemic, percutaneous cholecystostomy was performed as a temporizing measure. Laparoscopic cholecystectomy was subsequently performed at the earliest available operative opportunity. Intraoperatively, a complete torsion of the gallbladder with gangrenous changes was identified. The patient recovered uneventfully and was discharged home.
Discussion:
Gallbladder torsion remains difficult to diagnose preoperatively and may mimic acute acalculous cholecystitis. In this case, percutaneous cholecystostomy was undertaken based on the initial working diagnosis of acute acalculous cholecystitis and on the resource constraints present at the time. However, percutaneous drainage does not correct the mechanical torsion or associated vascular compromise and should not delay definitive surgery when gallbladder torsion is suspected.
Conclusion:
Gallbladder torsion should be considered in elderly, thin female patients presenting with features of acalculous cholecystitis. Persistent symptoms or clinical deterioration despite initial management should prompt reconsideration of the diagnosis. Once gallbladder torsion is suspected or confirmed, timely cholecystectomy remains the definitive treatment.