Diagnostic imaging in a patient with an isolated blunt traumatic gallbladder injury

Abstract

Isolated gallbladder injuries are very uncommon in blunt abdominal trauma due to its small size. Further, they are well protected by the surrounding liver, omentum, and the rib cage. A case of traumatic gallbladder injury in a 47-year-old man with progressive right hypochondrial pain is presented. The gallbladder injury was caused due to a blunt abdominal trauma after a motor vehicle accident. The patient had a history of chronic alcoholism and narcotics abuse. The patient was also human immunodeficiency virus-positive and was on stable treatment for tuberculosis. A diagnosis of gallbladder contusion with intramural dissection was made after an ultrasound and computed tomography scan. However, the patient refused surgery and thus, an ultrasound-guided percutaneous transhepatic drainage of the gallbladder was performed as a temporary treatment. Subsequently, a successful cholecystectomy was performed. Isolated traumatic gallbladder injury has been reviewed due to the rarity of this condition and the diagnostic challenges it poses.

Isolated Traumatic Gallbladder Injury: A Rare Case

“…Though our patient presented three days after his initial injury and his blood alcohol content at the time of injury was unknown, we postulate that the alcohol could contribute to the traumatic gallbladder injury, given his history. Similarly, most cited cases of gallbladder injury in blunt abdominal trauma had a history of alcohol use, and thus, it is an essential part of the history when considering differentials for patients with a gallbladder injury [2,4,8,11].…”

“…Cholecystectomies are one of the most common procedures performed in the operating room, with approximately 300,000 cholecystectomies performed annually [1]. However, the prevalence of gallbladder injury is relatively low in trauma settings due to surrounding parenchymal and rib protection and the small size of the gallbladder [2]. Gallbladder injury is only reported to be about 1.9%-2.1% of all abdominal traumas [3].…”

“…Furthermore, an isolated gallbladder injury in a case with blunt abdominal trauma is even rarer. A missed diagnosis of gallbladder injury can cause perforation from an intramural hematoma, which subsequently progresses to necrosis and severe infection [2]. A well-taken history is also imperative in weighing the probability of gallbladder injury, as chronic alcohol use increases its likelihood [4].…”

Imaging of Traumatic and Non-Traumatic Cystic Artery Bleeding

“…In trauma settings, multiphase CT represents the gold standard in stable patients as the first diagnostic step; CT can assess the presence of hemoperitoneum, the active bleeding and its source [18,19]. Isolated cystic artery trauma is an exceptional event, this may be explained by the protected anatomical location of the cystic artery course along the hepatobiliary triangle [18,20]. In blunt trauma, the more common presentation is hemoperitoneum with active extravasation due to cystic artery shear damage along its course within the gallbladder bed (Figure 2-4).…”