Case report: Gallbladder volvulus

Introduction: Gallbladder volvulus is a rare entity, with a predilection for elderly women in their 7th or 8th decades of life. The condition results in rotation of the gallbladder on its mesentery along the axis of cystic duct and artery. Presence of redundant mesentery is a prerequisite. The disease is a frequent mimicker of acute cholecystitis, often difficult to diagnose preoperatively. Till date only about 300 cases have been reported in the literature, with children and adolescent presentations being exceedingly rare. Case description: We report a case of an 18-year-old female who presented to emergency with right upper quadrant pain for a day associated with repeated vomiting. The patient was stable, had tenderness in right hypochondrium. Patient was evaluated as a potential case of acute cholecystitis. Laboratory investigations have shown normal white cell count, double normal liver function tests. Ultrasound showed that the gallbladder was out of the fossa with significant edema and wall thickness suggestive of gallbladder torsion. Further workup with MRCP was done, which showed retrohepatic gallbladder, with partial volvulus and hemorrhagic acalcular cholecystitis. The patient underwent laparoscopic detorsion and cholecystectomy and had an intraoperative evidence of gallbladder volvulus with gangrene with an uneventful course of hospital stay. Conclusion: We believe that this may be the first documented case of this rare condition from Qatar. Gallbladder volvulus mostly occurs in elderly, but it might occur in young patients as well and should be included in differential diagnosis of abdominal pain. Ultrasound is a safe, feasible diagnostic tool, as sensitive as MRI in diagnosis of gallbladder volvulus.