Isolated post-traumatic Intracholecystic Hemorrhage without Gallbladder Wall rupture: a rare diagnostic challenge

Blunt abdominal trauma rarely results in isolated gallbladder injury. Intracholecystic hemorrhage without concomitant liver injury or gallbladder wall rupture is an uncommon presentation. We report the case of a 55-year-old male presenting with epigastric pain following thoracoabdominal trauma. While initial non-contrast CT showed a distended gallbladder with some hyperdense endoluminal fluid, subsequent contrast-enhanced CT revealed active contrast extravasation into the gallbladder lumen, diagnostic of active bleeding, in the absence of hepatic injury. Despite initial hemodynamic stability prompting conservative management, follow-up imaging demonstrated a gallbladder lumen completely filled with hyperdense material and mild thickening of the gallbladder walls. This finding was interpreted as an increase in intracholecystic blood content, likely superimposed on the concomitant biliary excretion of contrast medium from the initial scan, necessitating laparoscopic cholecystectomy. This case highlights the role of multiphasic CT in diagnosing isolated gallbladder hemorrhage, which may require surgery despite intact walls.