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Shah A, Cho T, Bokhari F. Isolated Traumatic Gallbladder Injury: A Rare Case. Cureus 2023; 15:e43982. [PMID: 37746348 PMCID: PMC10516145 DOI: 10.7759/cureus.43982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
The prevalence of gallbladder injury in a traumatic event is rare, occurring in only 1.9%-2.0% of all abdominal traumas. Isolated gallbladder injuries, without any damage to surrounding organs or tissues, are even less common. Presenting symptoms are often nonspecific, and imaging modalities of ultrasound (US) and CT are usually relied upon to diagnose gallbladder injury accurately. Identifying and strategically treating cases of gallbladder injury, through reviewing this case report, are important for patient outcomes. We present a case of isolated gallbladder injury in a 27-year-old male after sustaining blunt-force abdominal trauma from a snowmobile injury. The patient presented to the emergency department (ED) three days after the initial injury with complaints of significant abdominal pain associated with eating solid food. Upon workup, he was found to have an isolated traumatic gallbladder injury for which a laparoscopic cholecystectomy was performed, and the patient was discharged with no complications. Gallbladder injury, with no evidence of other intra-abdominal injuries, is rare and often not considered in the differential for a trauma patient. Delayed intervention is associated with adverse patient outcomes, emphasizing the need to consider gallbladder injuries in patients presenting with abdominal pain, especially with a history of chronic alcohol use.
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Affiliation(s)
- Aashka Shah
- Surgery, Carle Illinois College of Medicine, Urbana, USA
| | - Timothy Cho
- General Surgery, Carle Foundation Hospital, Urbana, USA
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2
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Melkonian V, Sharp E, Moran V, Culhane J, Freeman C. Proposed management of traumatic blunt gallbladder injuries: A case of a pre-emptive laparoscopic cholecystectomy for suspected gallbladder avulsion after blunt traumatic liver injury. Trauma Case Rep 2022; 41:100685. [PMID: 36147542 PMCID: PMC9485518 DOI: 10.1016/j.tcr.2022.100685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/24/2022] [Accepted: 07/30/2022] [Indexed: 11/06/2022] Open
Abstract
Trauma is the leading cause of death among people aged 1–45 in the United States with the abdomen being the third most commonly injured anatomic region. The incidence of gallbladder trauma in the setting of abdominal injury ranges between 0.5 and 2.1 %. While gallbladder injuries secondary to penetrating abdominal wounds are found intra-operatively owing to the likely progression towards laparotomy, due to the paradigm shift of non-operative management of blunt liver injuries, the diagnosis of blunt gallbladder injuries are commonly delayed upwards of 1 to 6 weeks. 4 We present a case of a pre-emptive cholecystectomy less than 36 h after sustaining a grade V liver injury status post blunt abdominal trauma in effort emphasize the importance of critical review of diagnostic images, and support the utilization of diagnostic laparoscopy to definitively diagnose and manage traumatic blunt gallbladder injuries. When operative intervention is not performed, the nonspecific findings suggestive of gallbladder injuries can lead to delayed diagnosis and subsequent increased morbidity and mortality. Due to the lack of previous guidelines we propose a diagnostic algorithm for the approach of traumatic blunt gallbladder injuries.
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3
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Reitz MM, Araújo JM, de Souza GHN, Gagliardi DP, de Toledo FVT, Ribeiro Júnior MAF. Choleperitoneum secondary to isolated subserosal gallbladder injury due to blunt abdominal trauma – A case report. Trauma Case Rep 2022; 41:100674. [PMID: 35844962 PMCID: PMC9283662 DOI: 10.1016/j.tcr.2022.100674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/18/2022] Open
Abstract
When dealing with rare traumatic injuries, surgeons might have difficulty diagnosing them and choosing the most appropriate management when no consensus exist on the best course of action. In such circumstances, drawing on the experience of colleagues can be of great value. Traumatic injuries of the gallbladder are unusual and might not be readily identifiable neither in imaging studies nor during surgery. Retrograde cholangiography plays an important role in correctly diagnosing these injuries and guiding decision-making. We report a case of a subserosal perforation due to blunt trauma to the abdomen, which was identified intraoperatively after a transcystic retrograde cholangiogram was performed and managed successfully with formal cholecystectomy.
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Affiliation(s)
- Marianne Marchini Reitz
- Hospital Municipal Dr. José de Carvalho Florence, General Surgery Department, São José dos Campos, 12220-280 São Paulo, Brazil
- Humanitas - Faculdade de Ciências Médicas de São José dos Campos, São José dos Campos, 12220-611 São Paulo, Brazil
- Corresponding author at: Hospital Municipal Dr. José de Carvalho Florence Hospital Municipal Dr. José de Carvalho Florence, General Surgery Department, Rua Saigiro Nakamura, 800, São José dos Campos, 12220-280 São Paulo, Brazil.
| | - Júlio Muniz Araújo
- Hospital Municipal Dr. José de Carvalho Florence, General Surgery Department, São José dos Campos, 12220-280 São Paulo, Brazil
- Humanitas - Faculdade de Ciências Médicas de São José dos Campos, São José dos Campos, 12220-611 São Paulo, Brazil
| | | | - Danielle Pieretti Gagliardi
- Hospital Municipal Dr. José de Carvalho Florence, General Surgery Department, São José dos Campos, 12220-280 São Paulo, Brazil
| | - Flávius Vinícius Teixeira de Toledo
- Hospital Municipal Dr. José de Carvalho Florence, General Surgery Department, São José dos Campos, 12220-280 São Paulo, Brazil
- Humanitas - Faculdade de Ciências Médicas de São José dos Campos, São José dos Campos, 12220-611 São Paulo, Brazil
| | - Marcelo Augusto Fontenelle Ribeiro Júnior
- Hospital Municipal Dr. José de Carvalho Florence, General Surgery Department, São José dos Campos, 12220-280 São Paulo, Brazil
- Humanitas - Faculdade de Ciências Médicas de São José dos Campos, São José dos Campos, 12220-611 São Paulo, Brazil
- Pontifícia Universidade Católica de São Paulo, General and Trauma Surgery Department, Pontifícia Universidade Católica de São Paulo, Sorocaba 18030-070, São Paulo, Brazil
- Chair Division of Trauma, Burns, Surgical ICU and Acute Care Surgery. Sheikh Shakhbout Medical City – Mayo Clinic. Abu Dhabi - UAE
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4
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Woliansky J, Peng C, Loveday B, Hayes I. 'Radical' gallbladder avulsion due to blunt trauma. ANZ J Surg 2021; 92:1547-1548. [PMID: 34719863 DOI: 10.1111/ans.17328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/08/2022]
Affiliation(s)
- Jonathan Woliansky
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Calvin Peng
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin Loveday
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Ian Hayes
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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5
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Jang H, Park CH, Park Y, Jeong E, Lee N, Kim J, Jo Y. Spontaneous resolution of gallbladder hematoma in blunt traumatic injury: A case report. World J Clin Cases 2021; 9:8518-8523. [PMID: 34754862 PMCID: PMC8554416 DOI: 10.12998/wjcc.v9.i28.8518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/12/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury. We report that the patient was safely treated by conservative treatment after the obstruction was resolved by endoscopic retrograde cholangiopancreatography (ERCP).
CASE SUMMARY A 67-year-old man was admitted via the emergency department due to complaints of right-sided abdominal pain that started 2 d prior. Four days prior to presentation, the patient had slipped, fallen and struck his abdomen on a motorcycle handle. His initial vital signs were stable. On physical examination, he showed right upper quadrant pain and Murphy’s sign, with decreased bowel sounds. Additionally, he had had a poor appetite for 4 d. He had been on aspirin for 2 years due to underlying hypertension. Initial simple radiography revealed a slight ileus. The laboratory findings were as follows: white blood cell count, 15.5 × 103/µL (normal range 4.8 × 103–10.8 × 103); hemoglobin, 9.4 g/dL; aspartate aminotransferase/alanine transferase, 423/348 U/L; total bilirubin/direct bilirubin, 4.45/3.26 mg/dL; -GTP , 639 U/L (normal range 5–61 U/L); and C-reactive protein, 12.32 mg/dL (0–0.3). Abdominal computed tomography showed a distended gallbladder with edematous wall change and a 55 mm × 40 mm hematoma. Dilatation was observed in both the intrahepatic and common bile duct areas. Antibiotic treatment was initiated, and ERCP was performed, with hemobilia found during treatment. After cannulation, the patient’s symptoms were relieved, and after conservative management, the patient was discharged with no further complications. After 1-month follow-up, the gallbladder hematoma was completely resolved.
CONCLUSION In the case of traumatic injury to the gallbladder, conservative treatment is feasible even in the presence of hematoma.
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Affiliation(s)
- Hyunseok Jang
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Chang-Hwan Park
- Department of Internal Medicine, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Yunchul Park
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Euisung Jeong
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Naa Lee
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Jungchul Kim
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
| | - Younggoun Jo
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Hospital, Dong-gu 61469, Gwangju, South Korea
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Le MTP, Herrmann J, Groth M, Reinshagen K, Boettcher M. Traumatic Gallbladder Perforation in Children - Case Report and Review. ROFO-FORTSCHR RONTG 2021; 193:889-897. [PMID: 33535261 DOI: 10.1055/a-1339-1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Gallbladder perforation is a very rare finding in children. Clinical and radiografic presentations are often vague. Hence it is a challenging diagnosis, often missed during initial evaluation with potentially fatal consequences. The aim of this case report and review was to identify factors that might help to diagnose and manage future cases. METHODS We present a case of gallbladder perforation in an 8-year-old child after blunt abdominal trauma caused by a handlebar in which imaging modalities such as ultrasound and magnetic resonance imaging (MRI) helped us to determine proper management. We identified and evaluated comparable cases for isolated traumatic gallbladder injury. A review of the recent literature was performed by online search in Pubmed and Google Scholar using "gallbladder injury in children", "gallbladder perforation children", "blunt abdominal trauma children" as keywords. We focused on articles exclusively in the pediatric section. The literature from the period 2000-2020 was taken into account to review the state of the art in diagnosis and management. RESULTS AND CONCLUSION Recent literature for gallbladder injury in pediatrics is sparse compared to the adult counterpart. Only eight published cases of isolated gallbladder injury in children were identified. Since the onset of symptoms may not develop acutely and often develops in an indistinct manner, radiografic examinations play an important role in the diagnostic progress. The authors advise caution in cases of blunt abdominal trauma especially involving handlebars, intraperitoneal free fluid, and severe abdominal pain. We advocate high suspicion of gallbladder perforation if the gallbladder wall displays discontinuation or cannot be definitively differentiated in sonografic examination. Echogenic fluid within the gallbladder should always lead to suspicion of intraluminal bleeding. Repeated clinical and imaging examinations are mandatory since the onset of signs and symptoms may be delayed. KEY POINTS · Awareness of gallbladder perforation in blunt abdominal trauma of the upper abdomen.. · Particularly high index of suspicion in cases involving handlebar injuries.. · Repeated clinical and imaging examinations are highly recommended.. CITATION FORMAT · Le MT, Herrmann J, Groth M et al. Traumatic Gallbladder Perforation in Children - Case Report and Review. Fortschr Röntgenstr 2021; 193: 889 - 897.
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Affiliation(s)
- Melanie Thanh Phuong Le
- Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Paediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Groth
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Paediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Boettcher
- Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Biomechanical properties of abdominal organs under tension with special reference to increasing strain rate. J Biomech 2020; 109:109914. [PMID: 32807339 DOI: 10.1016/j.jbiomech.2020.109914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/29/2020] [Accepted: 06/21/2020] [Indexed: 01/27/2023]
Abstract
Currently, abdominal finite element models overlook the organs such as gallbladder, bladder, and intestines, which instead are modeled as a simple bag that is not included in the analysis. Further characterization of the material properties is required for researchers to include these organs into models. This study characterized the mechanical properties of human and porcine gallbladder, bladder, and intestines using uniaxial tension loading from the rates of 25%/s to 500%/s. Small differences were observed between human and porcine gallbladder elastic modulus, failure stress, and failure strain. Strain rate was determined to be a significant factor for predicting porcine gallbladder elastic modulus and failure stress which were found to be 9.03 MPa and 1.83 MPa at 500%/s. Human bladder was observed to be slightly stiffer with a slightly lower failure stress than porcine specimens. Both hosts, however, demonstrated a strain rate dependency with the elastic modulus and failure stress increasing as the rate increased with the highest elastic modulus (2.16 MPa) and failure stress (0.65 MPa) occurring at 500%/s. Both human and porcine intestines were observed to be affected by the strain rate. Failure stress was found to be 1.6 MPa and 1.42 MPa at 500%/s for the human and porcine intestines respectively. For all properties found to be strain rate dependent, a numerical model was created to quantify the impact. These results will enable researchers to create more detailed finite element models that include the gallbladder, bladder, and intestines.
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8
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Como JJ, Schieda J, Claridge JA. Laparoscopic Cholecystectomy after Isolated Blunt Gallbladder Trauma Resulting in Intraluminal Hemorrhage: Computed Tomography and Operative Findings. Am Surg 2020. [DOI: 10.1177/000313481307900411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John J. Como
- Department of Surgery MetroHealth Medical Center Cleveland, Ohio
| | - Jill Schieda
- Department of Radiology MetroHealth Medical Center Cleveland, Ohio
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9
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Gallbladder injury after blunt abdominal trauma: Imaging clues for diagnosis. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.735418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Lockie EB, Banting SP, Hui AYS. Handlebar versus gallbladder: A case of gallbladder rupture in blunt thoracoabdominal trauma without other major injury. Trauma Case Rep 2019; 23:100238. [PMID: 31388543 PMCID: PMC6677930 DOI: 10.1016/j.tcr.2019.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Samuel P Banting
- Department of General Surgery, The Royal Melbourne Hospital, Australia
| | - Aaron Y S Hui
- Department of General Surgery, The Royal Melbourne Hospital, Australia
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11
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Price D, Gurien L, Dennis J, Yorkgitis B. Gallbladder Rupture and Acute Thoracic Aortic Disruption after Blunt Trauma. Am Surg 2018. [DOI: 10.1177/000313481808400936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Philipoff AC, Lumsdaine W, Weber DG. Traumatic gallbladder rupture: a patient with multiple risk factors. BMJ Case Rep 2016; 2016:bcr-2016-216811. [PMID: 27756757 DOI: 10.1136/bcr-2016-216811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Isolated gallbladder rupture following blunt thoracoabdominal trauma is rare; gall bladder rupture is seen in <1% of blunt abdominal trauma. This case report describes a significant mechanism of blunt force injury resulting in an isolated gallbladder rupture. Risk factors for traumatic gallbladder rupture are reviewed and the authors propose that a stiff, cirrhotic liver may exacerbate shear forces in the gallbladder fossa and represents an important risk factor for blunt gallbladder injury. Cholecystectomy remains the definitive management for gallbladder trauma. Almost all gallbladder injuries following blunt trauma are associated with other significant intra-abdominal injuries and in the setting of acute trauma, the authors recommend an open procedure to facilitate a detailed exploration of the peritoneal cavity to exclude associated injuries.
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Affiliation(s)
- Adam Carl Philipoff
- Department of Trauma and General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - William Lumsdaine
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Dieter G Weber
- Department of Trauma and General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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13
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Gans B, Sodickson A. Imaging of Blunt Bowel, Mesenteric, and Body Wall Trauma. Semin Roentgenol 2016; 51:230-8. [PMID: 27287953 DOI: 10.1053/j.ro.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bradley Gans
- Department of Radiology, Division of Emergency Radiology, The Ohio State University, Columbus, OH.
| | - Aaron Sodickson
- Department of Radiology, Division of Emergency Radiology, Brigham and Women׳s Hospital, Boston, MA
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14
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Egawa N, Ueda J, Hiraki M, Ide T, Inoue S, Sakamoto Y, Noshiro H. Traumatic Gallbladder Rupture Treated by Laparoscopic Cholecystectomy. Case Rep Gastroenterol 2016; 10:212-7. [PMID: 27462188 PMCID: PMC4924469 DOI: 10.1159/000437046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy.
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Affiliation(s)
- Noriyuki Egawa
- Departments of Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Junji Ueda
- Departments of Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masatsugu Hiraki
- Departments of Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takao Ide
- Departments of Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Satoshi Inoue
- Departments of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuichiro Sakamoto
- Departments of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirokazu Noshiro
- Departments of Surgery, Faculty of Medicine, Saga University, Saga, Japan
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15
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Abstract
Gallbladder injury resulting from blunt abdominal trauma is rare, being found in only about 2% of patients who undergo laparotomy for abdominal trauma. Its small size and anatomic location—partially embedded in the liver tissue, surrounded by the omentum and intestines, and overlaid by the rib cage—provides good protection. Diagnosis can be difficult, and delay may result in the development of weight loss, nausea, vomiting, abdominal distension, jaundice, ascites, and abdominal pains. Delayed imaging with computed tomography can aid in diagnosis, especially in differentiating benign processes from true gallbladder injuries. Treatment for gallbladder injury is most commonly cholecystectomy. Mortality rates in patients with gallbladder injuries are related to associated injuries, including cardiac, thoracic or intra-abdominal hemorrhage, or multi-organ failure and/or brain damage. In isolated gallbladder injury, the prognosis is good.
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16
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Schattner A, Mavor E, Adi M. Unsuspected serious abdominal trauma after falls among community-dwelling older adults. QJM 2014; 107:649-53. [PMID: 24623857 DOI: 10.1093/qjmed/hcu050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In elderly community-dwelling patients who experience ground-level falls, fractures or brain injury are the major concern. Serious abdominal injury is seldom contemplated. AIM Identify all such patients presenting after a simple fall and admitted with serious blunt abdominal trauma to a single academic medical centre. DESIGN Retrospective chart analysis. METHOD All patients with both diagnoses aged 65 years or more admitted over 1 year to the department of medicine, geriatrics, surgery or urology were identified. RESULTS Out of 546 patients screened, three cases of ground-level falls leading to splenic rupture, isolated gallbladder rupture with gallstone ileus and perinephric hematoma were found (0.55%) and are reported. CONCLUSIONS Falls in elderly patients are exceedingly common mandating recognition of even rare complications. Physicians should be more aware of the possibility of occult and serious consequences of blunt abdominal trauma after falls among older adults, albeit rare.
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Affiliation(s)
- A Schattner
- From the Department of Medicine, Department of Surgery and Department of Radiology, Kaplan Medical Centre, Rehovot and Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - E Mavor
- From the Department of Medicine, Department of Surgery and Department of Radiology, Kaplan Medical Centre, Rehovot and Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - M Adi
- From the Department of Medicine, Department of Surgery and Department of Radiology, Kaplan Medical Centre, Rehovot and Hebrew University and Hadassah Medical School, Jerusalem, Israel
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17
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Hongo M, Ishida H, Naganuma H, Yoshioka H, Kasuya T, Niwa M. A case of gallbladder perforation detected by sonography after a blunt abdominal trauma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:301-304. [PMID: 24151110 DOI: 10.1002/jcu.22111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 06/14/2013] [Accepted: 09/10/2013] [Indexed: 06/02/2023]
Abstract
Gallbladder (GB) perforation is a very rare posttraumatic abdominal injury. It is potentially life-threatening, and good outcome requires early diagnosis. We present a case of isolated posttraumatic GB perforation in which the precise sonographic (US) diagnosis led us to apply proper management. Color Doppler US showed a clear to-and-fro flow signal passing through the perforation site, and contrast-enhanced US confirmed the presence of a small defect in the GB wall. When examining posttraumatic patients, the possibility of GB perforation must be kept in mind. Color Doppler US and contrast-enhanced US are the examinations of choice to detect the perforation site and show bile movement through the perforation.
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Affiliation(s)
- Maiko Hongo
- Department of Surgery, Yokote Municipal Hospital, 5-31 Negishi-cho, Yokote-shi, Akita, 013-8602, Japan
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18
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Abstract
Isolated gallbladder perforations following blunt abdominal trauma are very rare. They often present with insidious onset of symptoms a few days after the initial insult and an operative course of management ensues. This is in the form of a cholecystectomy and peritoneal lavage; more often via laparotomy rather than laparoscopically. Conservative management, in the form of cholecystostomy, percutaneous intraperitoneal drainage or cholecystorraphy has been described; however, these cases have invariably resulted in cholecystectomy eventually. The case uniquely highlights the successful non-operative management of isolated traumatic gallbladder perforation.
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Affiliation(s)
- Rohan Kumar
- Department of General Surgery, East Kent University NHS Foundation Trust, Ashford, Kent, TN24 0LZ, United Kingdom
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19
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Usui A, Kawasumi Y, Hosokai Y, Saito H, Igari Y, Funayama M. Fatal intra-abdominal hemorrhage as a result of avulsion of the gallbladder: a postmortem case report. Acta Radiol Short Rep 2013; 2:2047981613482898. [PMID: 23986858 PMCID: PMC3736968 DOI: 10.1177/2047981613482898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 02/25/2013] [Indexed: 12/08/2022] Open
Abstract
Gallbladder injuries are extremely rare in blunt trauma, with a reported incidence of <2%. We report an autopsy case of fatal hemorrhagic shock due to intra-abdominal bleeding resulting from complete avulsion of the gallbladder associated with liver cirrhosis. Multiplanar images derived from multislice computed tomography (MSCT) performed as part of pre-autopsy screening showed complete avulsion of the gallbladder without any other associated intra-abdominal injuries, facilitating forensic autopsy planning. In this report, we discuss the role of MSCT in cases of fatal intra-abdominal bleeding caused by avulsion of the gallbladder and discuss the mechanism of this injury.
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20
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Birn J, Jung M, Dearing M. Isolated gallbladder injury in a case of blunt abdominal trauma. J Radiol Case Rep 2012; 6:25-30. [PMID: 22690293 DOI: 10.3941/jrcr.v6i4.941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
The diagnosis of blunt injury to the gallbladder may constitute a significant challenge to the diagnostician. There is often a delay in presentation with non-specific clinical symptoms. In the absence of reliable clinical symptoms, diagnostic imaging becomes an invaluable tool in the rapid identification of gallbladder injury. We present a case of isolated gallbladder injury following blunt abdominal trauma which was diagnosed by computed tomography and subsequently confirmed by cholecystectomy.
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Affiliation(s)
- Jeffrey Birn
- Department of Radiology, Henry Ford Hospital, Detroit, MI, USA.
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Pavlidis TE, Lalountas MA, Psarras K, Symeonidis NG, Tsitlakidis A, Pavlidis ET, Ballas K, Flaris N, Marakis GN, Sakantamis AK. Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy): a case report and review of the literature. J Med Case Rep 2011; 5:392. [PMID: 21851630 PMCID: PMC3169498 DOI: 10.1186/1752-1947-5-392] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 08/18/2011] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Injury of the gallbladder after blunt abdominal trauma is an unusual finding; the reported incidence is less than 2%. Three groups of injuries are described: simple contusion, laceration, and avulsion, the last of which can be partial, complete, or total traumatic cholecystectomy. CASE PRESENTATION A case of isolated complete avulsion of the gallbladder (near traumatic cholecystectomy) from its hepatic bed in a 46-year-old Caucasian man without any other sign of injury is presented. The avulsion was due to blunt abdominal trauma after a car accident. The rarity of this injury and the stable condition of our patient at the initial presentation warrant a description. The diagnosis was made incidentally after a computed tomography scan, and our patient was treated successfully with ligation of the cystic duct and artery, removal of the gallbladder, coagulation of the bleeding points, and placement of a drain. CONCLUSIONS Early diagnosis of such injuries is quite difficult because abdominal signs are poor, non-specific, or even absent. Therefore, a computed tomography scan should be performed when the mechanism of injury is indicated.
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Affiliation(s)
- Theodoros E Pavlidis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Miltiadis A Lalountas
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Kyriakos Psarras
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Nikolaos G Symeonidis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Anastasios Tsitlakidis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Efstathios T Pavlidis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Konstantinos Ballas
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Nikolaos Flaris
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Georgios N Marakis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Athanassios K Sakantamis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
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Blunt abdominal trauma resulting in gallbladder injury: a review with emphasis on pediatrics. ACTA ACUST UNITED AC 2011; 70:1005-10. [PMID: 21610404 DOI: 10.1097/ta.0b013e3181fcfa17] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Gallbladder injury in blunt abdominal trauma is a rare and difficult diagnosis. Gallbladder injury is reported to be between 1.9% and 2.1% of all abdominal traumas. It has vague symptoms usually with inconclusive investigation results; hence, it is often diagnosed at laparotomy. The patient typically has vague abdominal pain and occasionally a period of remission depending on the type of gallbladder injury. In pediatrics, blunt abdominal trauma presents additional challenges of difficult historians and compensating physiology. Any delay in diagnosis and definitive management will worsen the prognosis. Making the diagnosis requires astute clinical acumen and radiologic interpretation. The classification system of Losanoff has merit in guiding treatment. While cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ and these are discussed. METHODS Literature searches were performed using Pubmed and Medline with keywords "abdominal trauma," "gallbladder injury," and "gallbladder perforation." DISCUSSION The authors highlight the incidence of associated visceral injuries in gallbladder trauma (>90%). Gallbladder perforation is more likely in cases when the gallbladder is distended and thin-walled at the time of injury. Therefore, we recommend that gallbladder perforation is suspected in those patients who have drunk alcohol or eaten recently. Despite the developments in modern computed tomography, identifying gallbladder perforation is difficult because of the subtlety and rarity of the condition. We draw attention to the proposed anatomic classification systems because they are of some use in guiding treatment. In the absence of a diagnosis after blunt abdominal trauma and with intra-abdominal free fluid, the clinician faces the difficult decision of whether surgery is indicated for a potential visceral injury. After discussing the available evidence, the authors advocate a low index of suspicion for performing diagnostic laparoscopy.
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Pascual I, Fernández Luengas D, Vaquero Pérez MA, Fernández Sánchez R, Torres Jiménez J. Tratamiento conservador del traumatismo penetrante de vesícula biliar. Cir Esp 2011; 89:196-7. [DOI: 10.1016/j.ciresp.2010.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/19/2010] [Accepted: 03/29/2010] [Indexed: 11/27/2022]
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Abstract
Minimally invasive techniques have now become standard for the treatment of many surgical conditions in children. During the past decade, there has been increasing interest in the use of this technology for the management of injured children. Laparoscopy has become an important adjunct in the evaluation of both blunt and penetrating intra-abdominal trauma and frequently is both diagnostic and therapeutic. Laparoscopic techniques have been used to repair injuries involving the gastrointestinal tract, solid organs, and the diaphragm. These procedures have been performed successfully, and avoid the complications associated with formal laparotomy.
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Affiliation(s)
- Barbara A Gaines
- Division of Pediatric General and Thoracic Surgery, Children’s Hospital of Pittsburgh/UPMC, One Children’s Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
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25
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Lin JC, Chu HC, Shen DHY. Abdominal distension in a 79-year-old patient. Gastroenterology 2010; 138:1250-1, 1634. [PMID: 20193789 DOI: 10.1053/j.gastro.2009.07.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 07/15/2009] [Indexed: 12/02/2022]
Affiliation(s)
- Jung-Chun Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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26
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McArthur C, Unnam S, Felsenstein I. Isolated blunt traumatic gallbladder perforation demonstrated on MDCT and post-cholecystectomy bile leak revealed on Gd-EOB-DTPA (Primovist) enhanced MRCP. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ejrex.2009.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Torres DM, Pathak AS, Pieri PG, Santora TA, Cohen G, Goldberg AJ, Seamon MJ. Ruptured gallbladder: delayed presentation after motor vehicle collision. THE JOURNAL OF TRAUMA 2009; 67:1451. [PMID: 20009703 DOI: 10.1097/ta.0b013e318182f79e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Denise M Torres
- Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Salomão RM, Magalhães NC, Silva FVD, Iglesias AC. Colecistite aguda decorrente de hemorragia intraluminar da vesícula biliar após trauma abdominal fechado. Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000500014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Akay HO, Senturk S, Cigdem MK, Bayrak AH, Ozdemir E. Isolated traumatic gallbladder rupture: US findings and the role of repeat US in diagnosis. Pediatr Radiol 2008; 38:691-3. [PMID: 18246337 DOI: 10.1007/s00247-008-0759-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 12/19/2007] [Indexed: 11/29/2022]
Abstract
We represent the US findings of isolated gallbladder rupture caused by blunt abdominal trauma in a 13-year-old boy. At the initial US examination, although a pericholecystic fluid collection was observed, the mildly collapsed gallbladder was regarded as a contracted gallbladder. Even though the patient was haemodynamically stable, repeat US examination after 24 h revealed gallbladder perforation. In haemodynamically stable trauma patients repeated US examinations can be useful and are strongly recommended.
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Tudyka V, Toebosch S, Zuidema W. Isolated Gallbladder Injury after Blunt Abdominal Trauma: a Case Report and Review. Eur J Trauma Emerg Surg 2007; 33:545-9. [PMID: 26814940 DOI: 10.1007/s00068-007-6202-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 05/15/2007] [Indexed: 12/29/2022]
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.
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Affiliation(s)
- Vera Tudyka
- Department of Surgery, Maasland Ziekenhuis Sittard, Walramstraat 23, Sittard, 6131 BK, The Netherlands. .,Department of Surgery, Maasland Ziekenhuis Sittard, Walramstraat 23, Sittard, 6131 BK, The Netherlands.
| | - Susan Toebosch
- Department of Gastroenterology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Wietse Zuidema
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
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31
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Bainbridge J, Shaaban H, Kenefick N, Armstrong CP. Delayed presentation of an isolated gallbladder rupture following blunt abdominal trauma: a case report. J Med Case Rep 2007; 1:52. [PMID: 17634139 PMCID: PMC1936994 DOI: 10.1186/1752-1947-1-52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 07/16/2007] [Indexed: 11/21/2022] Open
Abstract
Background Blunt injuries to the gallbladder occur rarely, and the incidence of isolated damage to the gallbladder is even smaller. We report a case of delayed presentation of isolated rupture of the gallbladder following blunt trauma to the abdomen. Case presentation A 65 year old lady presented through the Emergency Department with a 1 week history of blunt trauma to her abdomen. She complained of continued epigastric pain which radiated through to her back and right upper quadrant. On presentation, the patient had a low grade temperature, hypotension and mild tachycardia. Abdominal examination revealed right upper quadrant tenderness with no localised peritonism. C-reactive protein was 451. An abdominal CT showed a moderate amount of ascitic fluid in the perihepatic space. The patient underwent a laparotomy, which revealed a ruptured gallbladder with free bile. There was no evidence of any associated injuries to the surrounding organs. Partial cholecystectomy was done in view of the friable nature of the gallbladder. Post operatively, a persistent bile leak was managed successfully with endoscopic sphincterotomy and stenting. Conclusion Rupture of the gallbladder due to blunt injuries to the abdomen occurs from time to time and may constitute a diagnostic challenge especially with delayed presentation. Partial cholecystectomy is a safe option in cases where friability of the wall renders formal cholecystectomy inadvisable. Endoscopic sphincterotomy and stenting is a safe and effective treatment for persistent post operative bile leaks.
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Affiliation(s)
| | - Hossam Shaaban
- Department of Surgery, North Bristol NHS Trust, Bristol, UK
- Clinical Fellow Upper GI Surgery, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Nick Kenefick
- Department of Surgery, North Bristol NHS Trust, Bristol, UK
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Liess BD, Awad ZT, Eubanks WS. Laparoscopic cholecystectomy for isolated traumatic rupture of the gallbladder following blunt abdominal injury. J Laparoendosc Adv Surg Tech A 2007; 16:623-5. [PMID: 17243883 DOI: 10.1089/lap.2006.16.623] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Gallbladder rupture following blunt abdominal trauma is a rare event usually recognized on evaluation and treatment of other visceral injuries during laparotomy. Isolated gallbladder rupture secondary to blunt abdominal trauma is even more uncommon. Delay in the diagnosis of the injury for several days due to no, or vague, symptoms and an insidious course is common. Early diagnosis is essential, as protracted treatment may result in significant morbidity and mortality. We report the case of a patient who suffered isolated gallbladder rupture due to blunt abdominal trauma from a fall. We propose laparoscopic cholecystectomy as a safe and effective surgical treatment for this solitary injury.
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Affiliation(s)
- Benjamin D Liess
- Department of General Surgery, University of Missouri Hospital and Clinics, Columbia, Missouri 65212, USA
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33
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Sandor L, Kiss L. [Isolated injury of the gallbladder. A rare cause of hemorrhagic shock after blunt abdominal trauma in a patient with liver cirrhosis]. Chirurg 2006; 77:730-6. [PMID: 16437229 DOI: 10.1007/s00104-005-1137-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Isolated injuries to the gallbladder are extremely rare in blunt abdominal trauma, with a reported incidence of less than 2%. We report a case with partial avulsion of the gallbladder and subsequent hemorrhagic shock in a patient with liver cirrhosis. Although the gallbladder injury was demonstrated on CT images (with contrast enhancement in the bed of the gallbladder), the correct diagnosis was not established preoperatively. Emergency laparotomy revealed partial avulsion of the gallbladder and the underlying condition of severe liver cirrhosis with ascites. We estimate that the gallbladder avulsion occurred due to compressional waves of the ascites (during blunt abdominal injury) which may have sheared off the gallbladder from the cirrhotic liver. The patient received cholecystectomy, which is recommended as standard in case of gallbladder injury.
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Affiliation(s)
- L Sandor
- Abteilung für Unfallchirurgie der Universität zu Szeged, Hungary.
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34
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Affiliation(s)
- Steven Salzman
- Department of Trauma Surgery, Advocate Crist Hospital, Oak Lawn, Illinois 60453, USA.
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35
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Di Carlo I, Sparatore F, Primo S, Toro A. Gallbladder Blunt Trauma: Unusual Presentation and Difficult Diagnosis. Visc Med 2006. [DOI: 10.1159/000095066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Affiliation(s)
- Aaron Wittenberg
- Department of Radiology, MetroHealth Medical Center, Cleveland, OH 44109, USA.
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37
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Affiliation(s)
- Eddy H Carrillo
- Division of Trauma and Critical Care, Memorial Regional Hospital, Hollywood, Florida 33021, USA.
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38
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Brennan PM, Welsh FKS, Lyness C, Bathgate AJ, Wigmore SJ. Avulsion of the gallbladder following trivial injury. Int J Clin Pract 2004; 58:318-21. [PMID: 15117105 DOI: 10.1111/j.1368-5031.2004.00062.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Traumatic cholecystectomy is a rare condition that has always been described in the context of major trauma and associated liver or biliary injuries. We present a case of isolated traumatic cholecystectomy following a trivial injury which resulted in both a delayed presentation and a difficult diagnosis.
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Affiliation(s)
- P M Brennan
- Department of Clinical and Surgical Sciences (Surgery), The University of Edinburgh, Royal Infirmary, Edinburgh, UK
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39
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Affiliation(s)
- X Chen
- Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499, USA
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40
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Sugiyama M, Abe N, Masaki T, Mori T, Atomi Y. Endoscopic biliary stent placement for treatment of gallbladder perforation due to blunt abdominal injury. Gastrointest Endosc 2000; 52:275-7. [PMID: 10922111 DOI: 10.1067/mge.2000.106671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M Sugiyama
- First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
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41
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Velez SE, Llaryora RG, Lerda FA. Laparoscopic cholecystectomy in penetrating trauma. J Laparoendosc Adv Surg Tech A 1999; 9:291-3. [PMID: 10414549 DOI: 10.1089/lap.1999.9.291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Laparoscopy in trauma is useful in diagnosing but limited in treatment. We report the case of a patient with a stab wound in the right upper quadrant and gallbladder perforation who underwent diagnostic and laparoscopic treatment. The therapeutic opportunities in abdominal trauma are scant for laparoscopic surgery; the isolated gallbladder injury is one of them, it being possible to apply the usefulness of this less invasive technique in this case.
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Affiliation(s)
- S E Velez
- Department of Surgery, Hospital de Urgencias de Cordoba, Argentina.
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42
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Ferrera PC, Verdile VP, Bartfield JM, Snyder HS, Salluzzo RF. Injuries distracting from intraabdominal injuries after blunt trauma. Am J Emerg Med 1998; 16:145-9. [PMID: 9517689 DOI: 10.1016/s0735-6757(98)90032-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
While most conscious patients with severe intraabdominal injuries (IAI) will usually present with either abdominal pain or tenderness, there is a small group of awake and alert patients in whom the physical examination will be falsely negative because of the presence of associated extraabdominal ("distracting") injuries. We sought to define the types of extraabdominal injuries that could lead to a false negative physical examination for potentially severe IAI in adult victims of blunt trauma. This study was prospectively performed on consecutive blunt trauma patients over a 14-month period in our level I trauma center. Inclusion criteria were as follows: (1) Glasgow Coma Scale score of 15; (2) age 18 years or older; and (3) computed tomography (CT) of the abdomen or diagnostic peritoneal lavage (DPL) performed regardless of initial physical examination findings. Patients were questioned specifically about the presence of abdominal pain and the initial abdominal examination was documented in addition to other extraabdominal injuries. Abdominal injuries were considered to be present based upon either abdominal CT findings or a positive DPL. Patients with and without abdominal pain or tenderness were compared for the presence of IAI. A total of 350 patients were enrolled. There were 142 patients with neither abdominal pain nor tenderness (group 1) and 208 patients with either or both (group 2). Ten of the 142 patients (7.0%) in group 1 had IAI compared with 44 of the 208 patients (21.2%) in group 2 (P = .0003). Presence of pain and/or tenderness had a sensitivity of 82%, a specificity of 45%, a positive predictive value of 21%, and negative predictive value of 93%. All 10 patients in group 1, and 36 of the 44 group 2 patients, had associated extraabdominal injuries. Although the presence of abdominal pain or tenderness was associated with a significantly higher incidence of IAI, the lack of these findings did not preclude IAI.
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Affiliation(s)
- P C Ferrera
- Department of Emergency Medicine, Albany Medical Center, NY 12208, USA
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