{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T15:42:18Z","timestamp":1793374938326,"version":"4.5.0"},"reference-count":15,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,11,24]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.<\/jats:p>","DOI":"10.1136\/bcr-2020-237842","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T12:55:15Z","timestamp":1609937715000},"page":"e237842","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Torsion of the gallbladder: a rare but important differential to consider when treating acute cholecystitis non-operatively"],"prefix":"10.1136","volume":"14","author":[{"given":"Arun","family":"Ahluwalia","sequence":"first","affiliation":[{"name":"Blacktown Hospital, Blacktown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew George Roy","family":"Allaway","sequence":"additional","affiliation":[{"name":"Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Giga","sequence":"additional","affiliation":[{"name":"Blacktown Hospital, Blacktown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard James","family":"Curran","sequence":"additional","affiliation":[{"name":"Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,1,6]]},"reference":[{"key":"2025082711135976000_14.1.e237842.1","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.12659\/AJCR.916234","article-title":"A rare presentation of gall bladder volvulus: a case report","volume":"20","author":"Kachi","year":"2019","journal-title":"Am J Case Rep"},{"key":"2025082711135976000_14.1.e237842.2","article-title":"Expect the unexpected: torsion of the gallbladder, a rare cause for acute cholecystitis","volume":"10","author":"Hwang","year":"2018","journal-title":"Cureus"},{"key":"2025082711135976000_14.1.e237842.3","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1936.01180190134008"},{"key":"2025082711135976000_14.1.e237842.4","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1111\/j.1477-2574.2012.00513.x","article-title":"Torsion of the gallbladder: a systematic review","volume":"14","author":"Reilly","year":"2012","journal-title":"HPB"},{"key":"2025082711135976000_14.1.e237842.5","unstructured":"Afdhal NH . Acalculous cholecystitis: clinical manifestations, diagnosis and management. UpToDate web site. Available: https:\/\/www.uptodate.com.acs.hcn.com.au\/contents\/acalculous-cholecystitis-clinical-manifestations-diagnosis-and-management [Accessed 26 Apr 2020]."},{"key":"2025082711135976000_14.1.e237842.6","doi-asserted-by":"crossref","first-page":"80","DOI":"10.7812\/TPP\/12-118","article-title":"A clinician's guide to the diagnosis and management of gallbladder volvulus","volume":"17","author":"Pottorf","year":"2013","journal-title":"Perm J"},{"key":"2025082711135976000_14.1.e237842.7","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1177\/000313481908500522","article-title":"Surgical results of laparoscopic cholecystectomy for gallbladder torsion","volume":"85","author":"Ezaki","year":"2019","journal-title":"Am Surg"},{"key":"2025082711135976000_14.1.e237842.8","article-title":"First report of gallbladder volvulus managed with a robotic approach","volume":"2019","author":"Bustos","year":"2019","journal-title":"Case Rep Surg"},{"key":"2025082711135976000_14.1.e237842.9","doi-asserted-by":"crossref","first-page":"403","DOI":"10.4240\/wjgs.v7.i12.403","article-title":"Laparoscopic management of a two staged gall bladder torsion","volume":"7","author":"Sunder","year":"2015","journal-title":"World J Gastrointest Surg"},{"key":"2025082711135976000_14.1.e237842.10","doi-asserted-by":"crossref","first-page":"296","DOI":"10.7863\/jum.1993.12.5.296","article-title":"Preoperative sonographic diagnosis of gallbladder torsion: report of two cases","volume":"12","author":"Safadi","year":"1993","journal-title":"J Ultrasound Med"},{"key":"2025082711135976000_14.1.e237842.11","article-title":"Gallbladder volvulus: it's a small whirl","volume":"2","author":"Layton","year":"2016","journal-title":"BJR Case Rep"},{"key":"2025082711135976000_14.1.e237842.12","doi-asserted-by":"crossref","first-page":"14068","DOI":"10.3748\/wjg.v20.i38.14068","article-title":"Complete body-neck torsion of the gallbladder: a case report","volume":"20","author":"Pu","year":"2014","journal-title":"World J Gastroenterol"},{"key":"2025082711135976000_14.1.e237842.13","doi-asserted-by":"crossref","first-page":"235","DOI":"10.9738\/CC151.1","article-title":"Torsion of the gallbladder diagnosed by magnetic resonance cholangiopancreatography","volume":"97","author":"Fukuchi","year":"2012","journal-title":"Int Surg"},{"key":"2025082711135976000_14.1.e237842.14","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1089\/lap.2007.0057","article-title":"Laparoscopic treatment of gallbladder volvulus: a pediatric case report and literature review","volume":"18","author":"Kimura","year":"2008","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"2025082711135976000_14.1.e237842.15","first-page":"1","article-title":"A case of torsion of the gallbladder suspected with SPECT-CT: review and recommendations","volume":"2020","author":"Bergeron","year":"2020","journal-title":"Case Rep Surg"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-237842","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:14:09Z","timestamp":1756318449000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-237842"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,6]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1136\/bcr-2020-237842"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-237842","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}