Gallbladder volvulus (GV) is a rare but potentially life-threatening condition characterized by the torsion of the gallbladder around its vascular pedicle. It predominantly affects elderly females and is often underdiagnosed. We report the case of an 84-year-old female patient with a history of deep vein thrombosis on rivaroxaban, presenting with acute upper abdominal pain. On admission, the patient was hemodynamically stable but in a poor general condition. Physical examination revealed tenderness in the right upper quadrant without guarding. Laboratory tests showed significantly elevated inflammatory markers and electrolyte disturbances. Abdominal CT demonstrated a distended gallbladder located in the mid-abdomen with a thickened wall and mild ascites. No radiopaque gallstones were detected. Empirical intravenous antibiotic therapy with amoxicillin/clavulanic acid was initiated. Due to persistent symptoms and worsening inflammatory parameters, a laparoscopic cholecystectomy was performed after discontinuation of anticoagulation therapy. Intraoperatively, a 180° torsion of the gallbladder around the infundibulum was identified. Due to a lack of adequate visualization, conversion to an open cholecystectomy was performed. Histopathological examination confirmed transmural ischemia, hemorrhage, and purulent inflammation without malignancy. The postoperative course was uneventful, and the patient was discharged in good general condition on the 11th postoperative day. GV should be considered in elderly patients presenting with atypical acute cholecystitis symptoms. Prompt surgical intervention is essential to prevent severe complications such as gangrene and perforation.
Sato et al. (Sat,) studied this question.