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Traumatic Gallbladder Perforation in Children - Case Report and Review
Melanie Thanh Phuong Le1, Jochen Herrmann2, Michael Groth2
1Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
Gallbladder perforation is rare in children and often missed. High suspicion is crucial after blunt abdominal trauma, especially from handlebars, with repeated imaging aiding diagnosis.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Diagnostic Imaging
Background:
- Gallbladder perforation is a rare but serious condition in children, often presenting with vague symptoms.
- Diagnosis is challenging due to non-specific clinical and radiographic findings, potentially leading to fatal outcomes.
Observation:
- A case of gallbladder perforation in an 8-year-old following blunt abdominal trauma from a handlebar is presented.
- Ultrasound and MRI were instrumental in guiding management.
- A literature review identified only eight pediatric cases of isolated traumatic gallbladder injury between 2000-2020.
Findings:
- Gallbladder injuries in children are infrequently documented compared to adults.
- Delayed or indistinct symptom onset necessitates a high index of suspicion.
- Radiographic findings like gallbladder wall discontinuity or intraluminal echogenic fluid are critical diagnostic clues.
Implications:
- Clinicians should maintain a high suspicion for gallbladder perforation in pediatric blunt abdominal trauma, particularly handlebar injuries.
- Repeated clinical and imaging evaluations are essential for timely diagnosis and management.
- Prompt diagnosis and management of traumatic gallbladder injury can prevent severe complications.
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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