A rare case report of gallbladder perforation caused by trauma

Isolated gallbladder perforation in blunt trauma is rare, accounting for approximately 2% of abdominal trauma laparotomy patients, often leads to delayed diagnosis due to non-specific symptoms. We report a 23-year-old male who sustained self-inflicted blunt trauma to the right upper abdomen while intoxicated and riding an electric bicycle, colliding with a bollard. He presented 11 h later with diffuse peritonitis, right upper quadrant pain, tachycardia (HR 109 bpm), and hypertension (BP 149/104 mmHg). Initial ultrasound showed 58 mm abdominal effusion and an atrophic gallbladder; paracentesis revealed bile. To identify the source of peritoneal effusion, rule out arterial extravasation, and assess other organ damage, contrast-enhanced computed tomography was performed-and this imaging confirmed gallbladder perforation. Laparoscopic cholecystectomy was performed, revealing a 2 cm perforation and 300 ml bile effusion. Post-operative course included antibiotics, nutrition support, and uneventful recovery with discharge on day 17. This case underscores the diagnostic pitfalls, as initial suspicion of liver injury was disproven by imaging. Rarity and non-specificity necessitate high suspicion in intoxicated patients, where alcohol may contribute to gallbladder vulnerability. Contrast-enhanced CT is crucial for confirmation, and cholecystectomy remains definitive treatment to prevent peritonitis. Clinicians should consider gallbladder perforation in blunt trauma, especially with alcohol involvement, to enable timely intervention and improve outcomes.