Torsion of gall bladder leads to occlusion of the cystic duct and the cystic artery. This torsion can be complete (180^o – 360^o) or incomplete (< 180^o). Incomplete torsion causes obstruction of the bile duct and vascular supply may be spared. In complete obstruction both are compromised. This occlusion leads to an increased amount of bile in the lumen and a decreased flow of blood to the organ. Increased pressure in the lumen with ischemia leads to acute inflammation causing a surgical emergency.

• Enlarged and distended gallbladder.
• Torsion along the long axis of the peduncle.
• Thick edematous wall with mucosal congestion.

• Extensive necrosis of the wall.^[1]
• Findings may be similar to gangrenous cholecystitis due to severe ischemia.
• The GB wall shows almost complete coagulation necrosis with intramural hemorrhages.
• A thin layer of degenerated collagen fiber, derived from the mucosa and proper muscle, may be seen along the inner side, and a thin subserosal connective tissue layer may seen along the outermost side.