Isolated Traumatic Gallbladder Perforation

ABSTRACT

Injuries to the gallbladder are found in about only 2% of patients with blunt abdominal trauma, and isolated gallbladder perforation is even less common. The gallbladder is less accessible to trauma because it is partially embedded in the liver, cushioned by the surrounding omentum and bowel, and shielded by the rib cage. It is usually associated with other visceral injuries, especially the liver. The leakage of bile from a ruptured gallbladder may not immediately produce symptoms of peritonitis, making an early diagnosis difficult, and causes delays to treatment. A 47-year-old man presented to our emergency department complaining of diffuse abdominal pain after a pedestrian traffic accident, but his vital signs were stable. In the laboratory tests, his hemoglobin was normal, but his blood chemistry showed mild jaundice (bilirubin 3.6 mg/dl). An abdominal computed tomogram showed pericholecystic and a right paracolic fluid collection, with a collapsed gallbladder. The patient underwent an operation under a diagnosis of hemoperitoneum, and when the peritoneal cavity was entered, the gallbladder was ruptured at the fundus, and about 500 cc of bile had accumulated in the abdominopelvic cavity. The other visceral organs were non-specific. We report a case of an isolated rupture of the gallbladder, with a review of the associated literature.