Upon insufflation we encountered a massive, gangrenous gallbladder just sort of floating around on the right side of her abdomen. Completely unfixed from the liver it seemed, as if someone had already been by to remove it but forgot to extract it at the end of the case. With a little manipulation I was able to detorse the rotten sac and flip it over the liver. It had twisted around the axis of the cystic artery. I placed a couple of clips on the the important structures, bagged it, and drew it out of her forever. 90% of her gallbladder was completely untethered to her liver bed.
Gallbladder volvulus is a pretty rare phenomenon. 300 or so cases have been described in the literature. You can read your little heart out here, here and here. Most patients are elderly thin females. The pathophysiology under girding the disease is a poorly fixated, completely peritonealized gallbladder. Most of the time, a large percentage of the back wall of the gallbladder is adherent to the liver. This seems to fixate the GB pretty well and prevent unwelcome contortionist maneuverings. as above. In the elderly, loss of fat and general atrophy of tissues may contribute. The lady felt much better afterwards. She went home in a couple days, albeit unhappy about the hospital food. The fry had been dry. Who doesn't know how to cook fish?