Ischaemic gallbladder secondary to torsion: a rare cause of acute abdomen

Gallbladder torsion is an uncommon cause of acute abdomen that occurs when the gallbladder rotates around its mesentery, leading to vascular compromise and ischaemia. Although preoperative diagnosis is uncommon, certain imaging findings, including a floating gallbladder or twisting of the cystic pedicle, may raise suspicion.

A woman in her 70s presented with acute right upper quadrant pain and vomiting of less than 24-hour duration. Ultrasound demonstrated a markedly distended gallbladder with wall thickening and markedly reduced Doppler wall perfusion, while CT showed an abnormally oriented gallbladder with a possible twisted cystic pedicle. Given concern for vascular compromise, urgent surgical exploration was performed. Intraoperatively, the gallbladder was found to be freely mobile and twisted around the cystic duct and artery with ischaemic changes. Robot-assisted laparoscopic cholecystectomy was completed without complication. Histopathology confirmed transmural ischaemic necrosis.

Gallbladder torsion should be considered in elderly patients presenting with abrupt right upper quadrant pain, low body habitus, and imaging findings that may overlap with acute cholecystitis.