Isolated Gallbladder Injury after Blunt Abdominal Trauma: a Case Report and Review

Abstract

We describe a case of isolated gallbladder contusion after deceleration trauma. On admission, no evident signs of intra-abdominal injury were present. However, after 24 h observation an explorative laparotomy was performed because of persistent abdominal complaints. A contusion of the gallbladder wall was found with intraluminal haematoma and a cholecystectomy was performed. Isolated injury of the gallbladder after blunt trauma is extremely rare. Risk factors are distention of the gallbladder, deceleration trauma and the presence of a relatively mobile gallbladder. Clinical signs often are very subtle. Delayed presentation is common with signs of hemobilia or obstruction due to intraluminal clots. Ultrasound and computed tomography are suitable diagnostic tools. However, the diagnosis is often missed if no other injuries are present. Signs pointing to gallbladder injury are a collapsed gallbladder with pericholecystic fluid or a hydroptic gallbladder with intraluminal hematoma. Hepatobiliary scintigraphy or angiography might be necessary if additional injuries are suspected. The choice of treatment depends on the kind of injury. Contusion of the gallbladder allows conservative treatment, but in case of a rupture, surgery will be necessary. Accompanying bile duct injuries can be treated by endoscopic stenting. If active arterial bleeding is present, selective embolization can be performed.

Proposed management of traumatic blunt gallbladder injuries: A case of a pre-emptive laparoscopic cholecystectomy for suspected gallbladder avulsion after blunt traumatic liver injury

“…In addition, food ingestion causing a distended gallbladder, or alcohol intake leading to increased sphincter of Oddi tonicity and increased bile in the biliary tree may also predispose to injury [5] . Injury patterns of the gallbladder include contusions, rupture, and avulsions, including partial, total, and traumatic cholecystectomy [2] , [3] , [4] .…”

“…Although not entirely immune to blunt forces, the incidence of gallbladder trauma in the setting of abdominal injury ranges between 0.5 and 2.1 % [2] , [3] . The diagnosis of blunt gallbladder injury is commonly delayed upwards of one to six weeks [4] . We present a case of a pre-emptive cholecystectomy less than 36 h after sustaining a grade V liver injury status to emphasize critical review of diagnostic images, and support the utilization of diagnostic laparoscopy in the diagnosis and management of traumatic blunt gallbladder injuries.…”

Künt Travmaya Bağlı İzole Safra Kesesi Hematomunda Konservatif Tedavi

“…Along with the multiorgan injuries, gallbladder injuries have mortality about the %24 rate, also 49% of them were severely injured with unstable hemodynamic status. 7 The mortality and morbidity depend on complications of accompanying injuries (8).…”

Spontaneous resolution of gallbladder hematoma in blunt traumatic injury: A case report

“…In a blunt trauma case reported by Tudyka et al [ 12 ], a hydroptic gallbladder with intraluminal hematoma and dilatation of the common bile duct was found in the patient’s CT scan. Without other options, the patient underwent explorative laparotomy, and cholecystectomy was performed.…”