Importance of Investigating Occult Gallbladder Injury in Hepatic Trauma: A Case Report

Area of Science:

• Trauma Surgery
• Gastroenterology
• Abdominal Imaging

Background:

• Blunt abdominal trauma is a significant cause of injury, but gallbladder damage is uncommon and frequently overlooked.
• Delayed presentation of gallbladder injury can complicate diagnosis and management.

Observation:

• A 65-year-old male with blunt abdominal trauma presented with abdominal pain and initial stable vitals.
• Initial imaging showed a hepatic injury and mild gallbladder wall thickening; conservative management was initiated.
• The patient developed worsening symptoms including right upper quadrant pain, fever, and a positive Murphy's sign.

Findings:

• Abdominal ultrasound revealed gallbladder wall thickening and intraluminal clots.
• Laparoscopic cholecystectomy confirmed gallbladder contusion with an intramural hematoma and intraluminal clots.
• The hepatic injury was stable, with no active bleeding observed during surgery.

Implications:

• This case underscores the need for high clinical suspicion for occult gallbladder injuries in blunt abdominal trauma patients.
• Persistent symptoms despite initial stable imaging warrant further investigation and close follow-up.
• Prompt surgical intervention is vital to prevent severe complications such as bile peritonitis and sepsis.