A rare case of gallbladder torsion with incidental stage IIIB gallbladder adenocarcinoma.

Abstract

Gallbladder torsion is rare and can mimic acute cholecystitis. We report an 83-year-old female who presented with abdominal pain, leukocytosis, and hyperbilirubinemia. Work-up showed a distended, thick-walled gallbladder with stones and suspected choledocholithiasis. Because of worsening pain and concern for impending perforation, she underwent urgent cholecystectomy, which revealed a freely mobile gallbladder consistent with torsion. Final pathology showed a 0.4 cm poorly differentiated adenocarcinoma with metastatic involvement of a cystic duct lymph node (stage IIIB). Postoperatively, she underwent endoscopic retrograde cholangiopancreatography and removal of a retained common bile duct stone. Staging positron emission tomography/computed tomography demonstrated no residual or metastatic disease. Because the gallbladder was detached from the liver bed due to torsion, no further hepatic resection was performed, and systemic chemotherapy was recommended. This case illustrates both the diagnostic challenge of gallbladder torsion and a novel management consideration for incidentally discovered gallbladder cancer in the setting of a floating gallbladder.