Preoperative Diagnosis of Gallbladder Volvulus: A Case Report.

Gallbladder volvulus is a rare condition caused by rotation of the gallbladder around the cystic duct and cystic artery. Because its clinical and radiological features often overlap with those of acute cholecystitis, preoperative diagnosis remains challenging, with historically only approximately 10% of cases recognized before surgery. We report the case of an 84-year-old woman who presented with a four-day history of epigastric pain radiating to the right upper quadrant. Abdominal computed tomography (CT) demonstrated a markedly distended gallbladder displaced completely outside its hepatic fossa, consistent with a floating gallbladder. Additional findings included mural thickening with absent enhancement, suggesting vascular compromise, and a twisted cystic pedicle producing a characteristic whirl sign. Together, these findings raised strong preoperative suspicion for gallbladder volvulus rather than routine acute cholecystitis. Emergency laparoscopy confirmed complete torsion of a gangrenous gallbladder. Detorsion followed by laparoscopic cholecystectomy was performed, and the patient recovered without postoperative complications. This case highlights the diagnostic importance of recognizing the combination of a floating gallbladder, absent mural enhancement, and a twisted cystic pedicle. Early identification of these CT findings may facilitate prompt surgical intervention and reduce the risk of ischemic complications.