Posttraumatic intra-gallbladder hemorrhage in a patient with liver cirrhosis

Nishiwaki, Manabu; Ashida, Hiroshi; Nishimura, Toshio; Kimura, Masaichi; Yagyu, Ryuichiro; Nishioka, Akihiko; Utsunomiya, Joji; Yamamura, Takehira

doi:10.1007/s005350050258

Cited by 19 publications

(17 citation statements)

References 11 publications

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“…Isolated blunt injury of the gallbladder is practically unknown. Searching relevant English literature, we only found five reports describing isolated gallbladder contusion [2][3][4][5][6].…”

Section: Review Of the Literature Epidemiologymentioning

confidence: 99%

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

Tudyka

Toebosch

Zuidema

2007

Eur J Trauma Emerg Surg

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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.

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Section: Review Of the Literature Epidemiologymentioning

confidence: 99%

“…Distention of the gallbladder as a result of alcohol ingestion or fasting, leads to a greater vulnerability of the gallbladder for injury [2,3,8,11]. In addition intoxication by alcohol may lead to relaxation of the abdominal wall, which normally offers a certain degree of protection to trauma [12].…”

Section: Review Of the Literature Epidemiologymentioning

confidence: 99%

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

Tudyka

Toebosch

Zuidema

2007

Eur J Trauma Emerg Surg

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“…Acute cholecystitis resulting from hemobilia was reported by Lee & Caruso [4] and Counichan et al [5]. There are a few previous case reports describing cholecystitis after posttraumatic intra-gallbladder hemorrhage, but none presented with acute cholecystitis [6,7]. We report the case of a patient who sustained an apparent minor trauma and presented a few days later with acute cholecystitis.…”

Section: Introductionmentioning

confidence: 78%

Posttraumatic Acute Cholecystitis Caused by Intra-Gallbladder Hemorrhage in a Patient with Anticoagulant Therapy

Kirshtein

Lantsberg

Duchno

et al. 2002

European Journal of Trauma

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Background: With aging of the population, the incidence of trauma victims who are on anticoagulant or antiplatelet treatment is increasing. These patients are at risk of serious hemorrhage even after relatively minor trauma. They can also show bleeding in unusual locations with unusual consequences. Case Study: We report a previously undocumented bleeding complication in an anticoagulated patient, namely a delayed presentation of acute cholecystitis, where cystic duct obstruction was due to bleeding into the gallbladder after blunt abdominal trauma.

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“…It is critical to promptly diagnose and treat injuries in cirrhotic trauma patients. Since bleeding complications are frequent in cirrhotic patients, early and aggressive correction of coagulation parameters and hypothermia is crucial [31] . Poor nutrition is common in these patients and low albumin is different in survivors and non survivors.…”

Section: Discussionmentioning

confidence: 99%

Pre-existing cirrhosis is associated with increased mortality of traumatic patients: Analysis of cases from a trauma center in East China

Chen

Ni²,

Gao³

et al. 2007

WJG

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AIM:To determine the impact of cirrhosis on trauma patients and define the factors predicting death. METHODS:The data on patients admitted to the trauma center from January 2000-2005 were studied retrospectively. The clinical variables were recorded and compared to identify the factors differentiating cirrhotic trauma survivors from non survivors. Child's classification criteria were derived from the reviewed charts of cirrhotic trauma patients to evaluate their predictive value in cirrhotic trauma. Trauma registry was also used to generate a trauma control group by matching for age, sex, abbreviated injury score (AIS) over the same period of time. The outcome variables compared were mortality rate, time of ICU and hospital stay. Results were expressed as mean ± SD. These data were analyzed by SPSS.11.0 statistical software. Univariate analysis was performed to identify significant medical factors for survivor and non survivors subjected to chi-square test.Fisher's exact test and Student's t test were performed to determine the statistical difference between cirrhotic and control groups. P < 0.05 was considered statistically significant. RESULTS:Poor prognosis of traum patients was associated with one or more of the following findings: ascitcs, hyperbilirubinemia (more than 2 mg/dL), hypoalbuminemia (less than 3.5 mg/dL), and prolonged prothrombin time (more than 12.5 seconds). Although Child's classification was used to predict the outcome in cirrhotic patients undergoing portacaval shunt procedures, no significant difference was found in mortality rate as a function of Child's classification. CONCLUSION:Cirrhosis is associated with a higher mortality, a longer time of ICU and hospital stay of trauma patients. It seems that treatment of trauma patients with pre-existing severe liver disease is a challenge to surgeons.

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Posttraumatic intra-gallbladder hemorrhage in a patient with liver cirrhosis

Cited by 19 publications

References 11 publications

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

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

Posttraumatic Acute Cholecystitis Caused by Intra-Gallbladder Hemorrhage in a Patient with Anticoagulant Therapy

Pre-existing cirrhosis is associated with increased mortality of traumatic patients: Analysis of cases from a trauma center in East China

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