The gallbladder is normally anchored to the liver. In a small number of people, it is not, hanging instead from a narrow stalk carrying its own artery and duct. When that happens, the organ can rotate on its stalk and cut off its own blood supply, a mechanical problem that leads to ischemia and, if nothing is done, to necrosis.
The trouble is that it looks almost exactly like ordinary gallbladder inflammation. In what its authors describe as the largest pooled review of the condition, published in HepatoBiliary Surgery and Nutrition in 2021, Swiss and American surgeons gathered 178 publications covering 477 patients and found the diagnosis was made before the operation in only 80 of them, or 17%. The rest were discovered by a surgeon already looking at the abdomen.
