Isolated Gallbladder Perforation Following Blunt Abdominal Trauma: A Case Report

Kwok-Wan Yeung ； Po-Ping Liu

《Journal of Radiological Science》 39卷2期 (2014/06) Pp. 51-55

https://doi.org/10.6698/JRS.201406_3902.04

並列摘要

Although infrequent, gallbladder injury occurs in approximately 2% of blunt abdominal trauma cases, which are most commonly caused by motor vehicle accidents. Furthermore, isolated gallbladder injury, including gallbladder perforation, is even more rare. A 39 year-old male patient fell down accidentally from a height of 3 m and was sustained injuries, causing right upper quadrant pain and laceration of the left facial region. Computed tomography (CT) of the facial bones showed fractures of the nasal bone and left maxilla. Additionally, CT of the abdomen revealed a 4-cm, round, mildly hyperdense gallbladder lesion. Intraperitoneal fluid was also observed. No further imaging evidence suggestive of additional internal organ injuries was found. Ultrasonography (US)-guided paracentesis was performed and 50 c.c. of dark green fluid was aspirated. The fluid was confirmed to be bile ascites. US revealed heterogeneously hypoechoic content inside the gallbladder. Therefore, the patient was diagnosed with gallbladder hematoma and perforation. Emergent laparotomy uncovered a 2-cm perforation in the anterior wall of the gallbladder and 1500 c.c. of turbid ascites was removed. Cholecystectomy was performed and no additional intra-abdominal injuries were noted. This case demonstrates that accurate preoperative diagnosis with CT and US, and, if necessary, paracentesis can prompt emergent laparotomy to reduce patient morbidity and mortality.