A comorbid 67 year old female with Parkinson’s disease initially presented with acute onset severe right upper quadrant pain radiating to her mid-thoracic back, right upper quadrant tenderness, and normal examination and vitals. A CT-aortogram demonstrated an enlarged gallbladder and pericholecystic fluid, pathology found elevated white cells, normal UEC and LFT. MRCP showed no evidence of cholelithiaisis and was treated as acalculous cholecystitis with intravenous antibiotics. Given coinciding pneumonia anaesthetic review found she was unfit for acute operative management. After clinical improvement the patient was discharged home for staged elective surgery. Two months later she underwent laparoscopic cholecystectomy. Intraoperative findings identified an organo-axial torsion of the gallbladder whereby adhesions had tethered the gallbladder fundus in a 360 degree rotation. We performed careful adhesiolysis, detorsion of the gallbladder and cholecystectomy. She had an uneventful postoperative course and was seen in the clinic doing well. Torsion or volvulus of the gallbladder is rare with less than 600 cases in the literature since first described in 1898 (1). Lau et al described the triad of patient characteristics, symptoms and physical examinations (2). We highlight the imaging and clinical features that should twist the surgeon's arm to consider early operation and a potential twist on acalculous cholecystitis. 1/ Reilly DJ, Kalogeropoulos G, Thiruchelvam D. Torsion of the gallbladder: a systematic review. HPB. 2012 Oct 1;14(10):669-72. 2/ Lau WY, Fan ST, Wong SH. Acute torsion of the gallbladder in the aged: a re‐emphasis on clinical diagnosis. Australian and New Zealand Journal of Surgery. 1982 Oct;52(5):492-4.