Acute Gallbladder Volvulus in a 93-Year-Old High-Risk Patient: A Case Report.

BACKGROUND A gallbladder volvulus is a rare and life-threatening emergency requiring immediate surgery to prevent gallbladder perforation and sepsis. A correct preoperative diagnosis is often difficult. CASE REPORT We describe the case of a 93-year-old woman with an acute gallbladder volvulus that was initially misdiagnosed as acalculous cholecystitis. She was started on i.v. antibiotics for conservative management due to a symptomatic, high-grade aortic valve stenosis. After her clinical condition worsened, an emergency cholecystectomy was scheduled. After an interdisciplinary discussion with our anesthesia team, a laparoscopic approach with a low-pressure pneumoperitoneum was chosen and a low threshold for conversion was agreed upon in case of any hemodynamic problems during surgery. Intraoperatively, a necrotic, hemorrhagic gallbladder was found, caused by a 360° torsion of the gallbladder around the cystic duct/cystic artery axis in a counterclockwise direction. A laparoscopic cholecystectomy was successfully performed and the patient tolerated the procedure well. There were no intraoperative or postoperative complications and the patient was discharged home. CONCLUSIONS A gallbladder volvulus is an acute surgical emergency requiring immediate laparoscopic exploration and cholecystectomy. The correct preoperative diagnosis is rarely made due to often non-specific findings in preoperative ultrasound or CT imaging. Clinicians should be aware of certain risk factors for an acute gallbladder volvulus such as old age, female sex, and slender build, especially in patients with presumed acalculous cholecystitis, to prevent life-threatening complications caused by a delayed diagnosis. Laparoscopic surgery can be attempted in patients with symptomatic high-grade aortic valve stenosis.