A 9-year-old male presented to the emergency department with a 1-day history of periumbilical abdominal pain migrating to the right lower quadrant, 5–6 episodes of nonbilious emesis, and anorexia. Sagittal power Doppler sonographic image of the right upper quadrant (a) demonstrated marked echogenic mural thickening of the dilated gallbladder neck (N) and proximal cystic duct (CD) with adjacent hematoma (H). The dilated cystic duct tapered abruptly and there was diminished vascularity of the thick gall bladder wall. Coronal T1-weighted 2D fast spoiled gradient echo MRI (b) demonstrated markedly increase mural and intraluminal T1 signal representing hemorrhagic products. Intraoperative photograph (c) was obtained after de-torsion and division of the cystic duct and artery, demonstrating an enlarged gallbladder with intramural hemorrhage. Pathology evaluation confirmed a diagnosis of hemorrhagic necrosis of the gall bladder secondary to volvulus.