Laparoscopic common bile duct exploration can be successfully undertaken in a rural setting by general surgeons who have appropriate laparoscopic experience, and should be the procedure of choice for the management of choledocholithiasis in these patients. It should not be restricted to specialized surgical departments in major referral centres.

Gallbladder torsion is a rare cause for acute cholecystitis. Gallbladder torsion is unlikely to respond to conservative management and requires urgent surgical intervention. We report a case of an 85-year-old female with gallbladder torsion. She presented with a clinical picture consistent with acute cholecystitis. Radiological findings showed signs that elude to the diagnosis and intra-operative findings showed a complete torsion with a free-floating gallbladder. This case highlights the need to have a high index of suspicion for gallbladder torsion as a differential diagnosis for right upper quadrant (RUQ) pain apart from the typical calculous acute cholecystitis, especially in high risk groups such as thin, elderly females. Prompt decision for cholecystectomy is necessary and is likely to result in a good outcome.

No abstract