Virginia Research Day 2025

Medical Student Research Case Reports

03 Gallbladder Volvulus Masquerading as Gastric Volvulus: A Diagnostic Challenge in an Elderly Patient

Paige O’Brien Daly, MA¹; Kaylie Ward¹; Dan Ferman, MD²; Brian Lenczewski, MD² Corresponding author: pdaly@vcom.edu

¹ Edward Via College of Osteopathic Medicine - Virginia Campus ² Riverside Family Medicine General Surgery, Newport News, VA

Background: Gallbladder volvulus is a rare condition characterized by twisting of the gallbladder around its mesentery, leading to ischemia and potential necrosis. It predominantly affects elderly women and can mimic more common acute abdominal pathologies, making preoperative diagnosis challenging. With fewer than 500 reported cases in the literature, gallbladder volvulus remains an uncommon but clinically significant entity that requires prompt recognition and surgical intervention.

Case Summary: An 88-year-old female presented to the emergency department with epigastric pain and vomiting. Initial CT imaging revealed a large hiatal hernia containing the stomach, leading to a preliminary diagnosis of gastric volvulus. However, intraoperative findings during diagnostic laparoscopy unexpectedly revealed gallbladder volvulus with resultant gangrenous cholecystitis. The patient underwent successful laparoscopic cholecystectomy and placement of a percutaneous endoscopic gastrostomy tube.

Conclusion: This case highlights the diagnostic challenges associated with gallbladder volvulus, particularly in elderly patients with complex medical histories and concurrent anatomical abnormalities. It emphasizes the importance of maintaining a high index of suspicion for rare conditions in acute abdominal presentations and underscores the value of diagnostic laparoscopy in clarifying complex intra abdominal pathologies. Clinicians should consider gallbladder volvulus in the differential diagnosis for elderly patients presenting with symptoms suggestive of acute cholecystitis or other acute abdominal conditions, even when imaging studies suggest alternative diagnoses.

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