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[Traumatic gallbladder rupture in a 9-year-old child]
R Kh Shangareeva1, I G Chendulaeva2, V D Kovaleva2
1Bashkir State Medical University, Ufa, Russia.
Insights
Traumatic gallbladder rupture is rare, especially in children. This case highlights delayed peritonitis due to omental wrapping, emphasizing the need for comprehensive imaging in combined injuries.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Abdominal Imaging
Background:
- Gallbladder rupture following blunt abdominal trauma is an uncommon injury.
- Delayed presentation of peritonitis can occur due to protective mechanisms like omental wrapping.
Purpose of the Study:
- To report a rare case of traumatic gallbladder rupture in a pediatric patient.
- To discuss the diagnostic challenges and imaging findings associated with delayed presentation.
Main Methods:
- Case report of a 9-year-old boy with abdominal trauma.
- Clinical evaluation, serial ultrasounds, and intraoperative findings.
- Management included hemostatic therapy and cholecystectomy.
Main Results:
- Initial diagnosis focused on splenic injury and hemoperitoneum.
- Delayed peritonitis developed, attributed to a bile-soaked omentum obstructing the gallbladder tear.
- Ultrasound revealed gallbladder enlargement, heterogeneous content, and free fluid, indicative of rupture.
Conclusions:
- Traumatic gallbladder rupture can be challenging to diagnose, particularly with combined injuries.
- Omental wrapping can delay bile leakage and peritonitis.
- Comprehensive imaging, including computed tomography, is crucial for evaluating combined abdominal trauma.
Abstract:
We present gallbladder rupture following trauma. A 9-year-old boy admitted in 1.5 hours after injury. Considering clinical and ultrasound data, we diagnosed traumatic damage to the spleen and hemoperitoneum, biliary dyskinesia, cholestasis, sludge. Hemostatic therapy was carried out. After 3 days, signs of peritonitis appeared. Follow-up ultrasound revealed gallbladder enlargement with heterogeneous content, fluid in all parts of abdominal cavity. Intraoperatively, the gallbladder was enveloped in omentum soaked in bile. After mobilization of the gallbladder, we found longitudinal linear tear up to 3 cm clogged with omentum. Cholecystectomy was performed. Thus, we present a patient with combined injury and damage to the spleen. However, gallbladder wall thickening and heterogeneous content were interpreted as concomitant pathology. Delayed manifestation of peritonitis was due to gallbladder enveloped in omentum. The last one soaked in bile partially entered the gallbladder through perforation and prevented bile leakage into abdominal cavity. Timely diagnosis of gallbladder damage presents certain difficulties, especially in case of combined injury. Ultrasound signs of traumatic gallbladder rupture in this case were wall thickening, heterogeneous content and gradual gallbladder enlargement. It is necessary to analyze all organs at the damage site including computed tomography in patients with combined trauma.
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