Gall bladder volvulus: A rare surgical emergency masquerading as acute cholecystitis in a nonagenarian frail female – A case report

Gall bladder volvulus (GV) is an exceptionally rare surgical emergency characterised by the mechanical rotation of the organ along its cystic pedicle. It predominantly affects elderly, frail women and often masquerades as acute acalculous cholecystitis. A 96-year-old frail female presented with a 12-h history of acute right upper quadrant pain, nausea and vomiting. Despite a normal leucocyte count, computed tomography demonstrated a massively distended, horizontally displaced gall bladder with the pathognomonic ‘beak sign’ at the neck, indicating mechanical torsion. The patient underwent emergent laparoscopic cholecystectomy, which confirmed a 180° torsion of a ‘floating gall bladder’ with transmural necrosis. Following the administration of systemic meropenem, the patient had an uneventful recovery and was discharged on post-operative day 7. This case reinforces that GV is an absolute surgical mandate where pathognomonic imaging features must override non-specific inflammatory markers. Early laparoscopic intervention remains the gold standard to prevent fatal perforation and biliary peritonitis in the frail elderly population.