Isolated Gallbladder Perforation Following Blunt Abdominal Trauma: a case report

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. Correspondence Author to: Po-Ping Liu Department of Surgery, Fooyin University Hospital, Pingtung, Taiwan No. 5, Chung-Shan Road, Tung-Kang, Pingtung 928, Taiwan J Radiol Sci 2014; 39: 51-55 Isolated gallbladder perforation 52 J Radiol Sci June 2014 Vol.39 No.2 the abdomen with contrast-enhanced arterial and delayed venous phases revealed a 4-cm, round lesion in the minimally wall-thickened gallbladder (Fig. 1). The lesion was hyperdense, with an attenuation value of 70 H.U. on precontrast-enhanced CT. Intraperitoneal fluid with an attenuation value of approximately 5 H.U. was also seen in the abdominal and pelvic cavities. No increased contrast accumulation was identified inside the gallbladder on delayed venous phase. Furthermore, no additional imaging evidence of injuries to other internal organs was found. Therefore, intraluminal hematoma of the gallbladder was suspected based on CT findings. The interval between the traumatic event and the performance of abdominal CT was more than 12 hours. Due to the patient’s persistent right upper quadrant pain, paracentesis was performed in the right lower anterior abdomen under US guidance 2 hours after CT. A total of 50 mL of dark green fluid was aspirated and confirmed to be bile ascites with a total bilirubin level of 40 mg/dL and direct bilirubin level of 26 mg/dL. US of the gallbladder