Torsion of the gall-bladder: rare, unrecognized or under-reported?

Four cases of torsion of the gall-bladder are reported. The clinical features closely mimic those of acute cholecystitis. Although conservative management was initially instituted, close monitoring of our patients led to appropriate surgical intervention. Review of the literature suggests that torsion is uncommon. Four surgical registrars at busy district general hospitals seeing four cases in one year suggests that it is under-reported. Acute torsion can develop after a period of recurrent abdominal pain--retrospectively diagnosed as 'chronic torsion'. A prospective study using currently available imaging procedures to assess gall-bladder mobility, itself associated with torsion, could reveal whether this leads to chronic pain.