Torsion of a Wandering Gallbladder: An Extremely Rare Cause of Acute Abdomen Diagnosed on Multidetector Computed Tomography: Case Report with Pathognomonic Imaging Findings

Sachin Jain

Abstract: Background: Torsion (volvulus) of a wandering or floating gallbladder is an exceptionally rare surgical emergency caused by the absence or extreme attenuation of the normal peritoneal attachments of the gallbladder to the liver bed. The organ is suspended only by a long mesentery containing the cystic duct and artery, predisposing it to rotation about its vascular pedicle. Because the clinical presentation closely mimics acute cholecystitis or biliary colic, the diagnosis is almost never made clinically and rests entirely upon cross-sectional imaging. Case Presentation: We report the case of an elderly woman who presented with sudden-onset severe right upper quadrant pain, nausea and low-grade fever. Ultrasonography showed a markedly distended, thick-walled gallbladder lying unusually low in the abdomen with absent Doppler flow in the wall. Contrast-enhanced multidetector CT demonstrated complete absence of the gallbladder from its normal fossa, a massively distended and poorly enhancing gallbladder in the mid-abdomen, a ?beak sign? at the twisted cystic duct, and a whirl of the cystic artery and duct. These findings were diagnostic of gallbladder torsion with ischaemia. Management and Outcome: Emergency laparoscopic exploration confirmed a 360-degree anticlockwise torsion of a completely free-floating gallbladder. Detorsion revealed a gangrenous organ; cholecystectomy was performed. Histopathology confirmed transmural haemorrhagic necrosis. The postoperative course was uneventful. Conclusion: Recognition of an empty gallbladder fossa together with an ectopic, non-enhancing or poorly enhancing gallbladder and a twisted cystic pedicle on CT allows confident preoperative diagnosis of this life-threatening but curable condition. Early imaging diagnosis enables prompt surgical intervention before irreversible gangrene or perforation occurs.

Keywords: Gallbladder Torsion, Gallbladder Volvulus, Wandering Gallbladder, Floating Gallbladder, Acute Abdomen, Multidetector Computed Tomography

How to Cite?: Sachin Jain, "Torsion of a Wandering Gallbladder: An Extremely Rare Cause of Acute Abdomen Diagnosed on Multidetector Computed Tomography: Case Report with Pathognomonic Imaging Findings", Volume 15 Issue 8, August 2026, International Journal of Science and Research (IJSR), Pages: 196-199, https://www.ijsr.net/getabstract.php?paperid=MR26804025003, DOI: https://dx.doi.org/10.21275/MR26804025003

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