Preoperative diagnosis of gallbladder volvulus: Clinical case report and review of the literature

Introduction: Gallbladder volvulus is an uncommon disorder that impedes the circulation of fluid in the gallbladder and blood vessels. Gallbladder volvulus accounts for only 1 in 365,000 cases of gallstone disease. Wendell first described gallbladder volvulus and in the early 21st century, approximately 500 cases of gallbladder volvulus were reported as of early 2020. Despite technological advances in imaging modalities, the preoperative diagnosis of gallbladder volvulus remains very difficult with only 4 cases reported in the literature.
Clinical case: We report a rare case of complete acute gallbladder volvulus diagnosed preoperatively in a woman. An elderly female patient came to the emergency room with symptoms of acute cholecystitis. Ultrasound shows signs of an enlarged gallbladder, thick walls, and fluid around the gallbladder. The gallbladder has no stones, the intrahepatic and extrahepatic bile ducts are not dilated, and there are no stones. Computed tomography also shows similar images, along with images of twisting in the neck of the gallbladder. The laparoscopic cholecystectomy was indicated as an emergency. During surgery, we found the gallbladder was twisted 180 degrees counterclockwise at the gallbladder funnel, congested and necrotic. The patient had no complications and was discharged from the hospital on the 4th day after surgery.
Conclusion: Preoperative diagnosis of gallbladder volvulus is a challenge for clinicians. The combination of signs and symptoms with imaging findings can guide physicians to accurately and promptly diagnose preoperatively gallbladder volvulus. Early intervention helps prevent complications of sepsis due to gallbladder ischemia, necrosis and perforation, reducing mortality.