Gallbladder volvulus: A systematic review and patient-level synthesis of case reports and case series (2000-2026)

ABSTRACT Background and objective Gallbladder volvulus is a rare surgical emergency that may cause ischemia, gangrene, perforation, and death but often mimics acute cholecystitis. We systematically synthesized patient-level evidence on its presentation, diagnosis, operative findings, management, and outcomes. Methods The review was registered in PROSPERO (CRD420261459444). PubMed, Scopus, and Web of Science were searched for English-language case reports and case series published from January 1, 2000, through July 21, 2026. Two reviewers independently screened records and extracted data, resolving disagreements by consensus. Two reviewers independently performed Joanna Briggs Institute critical appraisal, with unresolved disagreements adjudicated by a third reviewer. Extractable case-series data were disaggregated and summarized descriptively using variable-specific denominators. Results We included 108 reports describing 129 surgically confirmed patients. Median age was 81.0 years (IQR 70.5–87.0; range 2.3–96.0), and 103 of 125 patients with reported sex were female (82.4%). Preoperative diagnosis was documented in 52 of 124 patients (41.9%). Among 117 patients with reported operative approach, 70 underwent laparoscopy, 42 open surgery, and 5 conversion to open surgery. Ischemia, gangrene, or necrosis was present in 106 of 111 patients (95.5%). Postoperative complications occurred in 16 of 120 patients (13.3%), and 3 of 120 died (2.5%). Initial laparoscopic management increased from 24.1% in 2000–2009 to 86.0% in 2020–2026. Conclusions Reported cases predominantly involved older adults and women but occurred across the age spectrum. Preoperative recognition remained limited, whereas ischemic compromise was common. These case-based proportions should not be interpreted as population prevalence, diagnostic accuracy, or comparative treatment effectiveness.