It should also be noted that the patient had eaten in the period preceding the trauma, and therefore the gallbladder was not enlarged in its fasted state. Although there has been an isolated case of injury secondary to a bull head-butting a patients' abdomen, there are no identifiable cases of damage occurring with this mechanism of injury. The majority of gallbladder injuries occur following motor vehicle incidents, significant falls and direct blows in sport e.g. This was also demonstrated by Wiener et al, showing that only half of the cases of gallbladder injury were in isolation. The incidence of isolated damage to the gallbladder is even smaller, as shown in Soderstrom's review whereby only 5 out 30 cases of gall bladder injuries were isolated. She was eventually discharged home 26 days after admission and the stent was removed 2 months later.īlunt injuries to the gallbladder occur rarely, ranging from 1.9%, as reported by Penn, to 2.1% in the series of patients examined by Soderstrom et al. Following this intervention the patient's post-op course was unremarkable apart from a small wound infection. During this procedure a sphincterotomy was performed and a pig-tail stent inserted to allow drainage of the gallbladder. An abdominal ultrasound at the time showed a continued fluid collection in the pelvis.ĭue to the continued bilious drainage the patient underwent an endoscopic retrograde cholangiopancreatography (ERCP) on day 6 post-op. There was continued leakage of bile through the drain site increasing in rate to approximately 300 mls per day for the next 48 hours. Unfortunately the drain came out unintentionally 3 days after the operation having drained almost 200 mls of bile in that period. Therefore the decision was made to perform a partial cholecystectomy, below the level of the tear, and drainage. Due to the friable nature of the gallbladder and associated inflammation cholecystectomy would have been extremely difficult. There was no evidence of any associated injuries to the surrounding organs. The patient underwent a laparotomy, which revealed a ruptured gallbladder with free bile. An abdominal computed tomogram (CT) was performed which showed a moderate amount of ascitic fluid in the perihepatic space, around the porta hepatis and extending down to the pelvis. Chest and abdominal radiographs were normal with no signs of free air. Bloods showed a normal full blood count, lipase and liver function but did however reveal a C-reactive protein of 451. Abdominal examination revealed right upper quadrant tenderness with no localised peritonism. On examination the patient had a low grade temperature (37.5☌) and was hypotensive at 96/61 mmHg, with a pulse rate of 96. She complained of continued epigastric pain following the incident, which radiated through to her back and right upper quadrant. Endoscopic sphincterotomy and stenting is a safe and effective treatment for persistent post operative bile leaks.Ī 65 year old lady presented through the Emergency Department with a 1 week history of abdominal pain after being knocked down by a horse she was holding, which resulted in the patient falling onto a stony path and hitting the right side of her abdomen. Partial cholecystectomy is a safe option in cases where friability of the wall renders formal cholecystectomy inadvisable. 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. Post operatively, a persistent bile leak was managed successfully with endoscopic sphincterotomy and stenting. Partial cholecystectomy was done in view of the friable nature of the gallbladder. An abdominal CT showed a moderate amount of ascitic fluid in the perihepatic space. On presentation, the patient had a low grade temperature, hypotension and mild tachycardia. She complained of continued epigastric pain which radiated through to her back and right upper quadrant. Case presentationĪ 65 year old lady presented through the Emergency Department with a 1 week history of blunt trauma to her abdomen. We report a case of delayed presentation of isolated rupture of the gallbladder following blunt trauma to the abdomen. Blunt injuries to the gallbladder occur rarely, and the incidence of isolated damage to the gallbladder is even smaller.
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