Gallbladder torsion is rare and is more frequently seen in elderly women. Published case reports comment that diagnosis of this entity can be made preoperatively through imaging with some advocating removal laparoscopically. This case reports an elderly woman who underwent emergency laparotomy for a massively distended gallbladder with suspected cholecystitis. At laparotomy the gallbladder was found to be torted over 360° round its pedicle of the cystic duct and artery. The torsion was so pronounced that the gallbladder was massively distended and grossly necrotic with a high risk of perforation. As the pedicle was long the gallbladder was easily separated form the liver and removed in its entirety. This case presented significant diagnostic and management difficulties. By observing the clinical features in the triad of triads for gallbladder volvulus prompt diagnosis, investigation and treatment can be started for this rare emergency presentation.

Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions.