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Trauma to the gallbladder is associated with concurrent injuries to the extra hepatic biliary system: A South African
Victor Kong1, William Xu2, Cynthia Cheung3
1Department of Surgery, University the Witwatersrand, Johannesburg, South Africa; Department of Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, University of KwaZulu Natal, Durban, South Africa.
Introduction:
Gallbladder trauma is a rare injury. This study aimed to describe the significance of these injuries and the appropriate management strategies.
Methods:
A retrospective study was undertaken at a major trauma centre in South Africa and included all patients diagnosed with a gallbladder injury between January 2012 and October 2020.
Results:
A total of 51 cases were included (88% male, mean age: 38 years), with 44 (86%) penetrating trauma cases [28 stab wounds (SW), 16 sustained gunshot wounds (GSW)]. Of the 7 (13%) blunt trauma cases, five were involved in a motor vehicle crash, and two were injured via assault. All patients underwent laparotomy. Full-thickness gallbladder laceration or perforation was the most common type of injury (84%) and all patients with a gallbladder perforation or laceration had a cholecystectomy at index operation. Two out of 5 patients with a gallbladder contusion were managed conservatively without a cholecystectomy and the remaining three had evidence of gallbladder necrosis which were managed with cholecystectomy. Associated extrahepatic bile duct injuries occurred in 4% of cases, and 18 cases (35%) required intensive care unit (ICU) admission. The overall mortality was 8%.
Conclusion:
Gallbladder injury is rare but when encountered implies a significant degree of trauma. Although cholecystectomy is usually definitive, there is an association with other occult extra-hepatic biliary tract injuries. The severity of the associated injuries usually determines patient outcomes.
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