North Texas Research Forum 2025
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Division
North Texas
Hospital
Medical City Plano
Specialty
General Surgery
Document Type
Poster
Publication Date
2025
Keywords
gallbladder injury, motor vehicle collision, car accident
Disciplines
Medicine and Health Sciences | Surgery | Trauma | Wounds and Injuries
Abstract
Introduction: Gallbladder injury accounts for less than 1% of the patient presenting with blunt abdominal trauma, due to its protected location in the undersurface of the liver. Case report: A 41-year-old male presented to the emergency department after a motor vehicle collision. Patient was hemodynamically stable; on exam, patient had focal tenderness in the lower abdomen. Initial lab results revealed elevated blood alcohol of 302 mg/dl, elevated lactate of 3.9 mmol/l, a white blood cell count of 6.76 K/mm3, and a hemoglobin of 15.2 g/dl. Patient was pan-scanned as per trauma protocol. A computed tomography scan revealed a mesenteric hematoma associated with the hepatic flexure of the colon and mural thickening suspicious for colonic serosal injury. A small amount of intraperitoneal fluid more evident in the perihepatic and perisplenic regions was seen without free air. The other associated injury was a right temporomandibular joint subluxation. Patient was initially managed with serial abdominal exams and hemoglobin trends but continued to have persistent abdominal pain with nausea and tachycardia. In view of worsening symptoms, the patient was taken up for a diagnostic laparoscopy on day 2 of presentation. Upon entry, a blood clot was visualized overlying the omentum, when rotated away from this region, revealed bile-stained bowel. At this point, we converted it to an open laparotomy. We dissected the omentum from the transverse colon and entered the lesser sac, further dissecting along the right lateral white line of Toldt to expose the ascending and transverse colon at the hepatic flexure, which revealed a perforated gall bladder. We performed a cholecystectomy in retrograde fashion after the cystic artery, accessory cystic artery, and cystic duct were identified and ligated. Pathology revealed a 1.5 cm defect in the fundus of the gall bladder. Patient did well postoperatively and was discharged on postoperative Day 4. Learning points: Gall bladder injuries from blunt abdominal trauma are rare due to its protected position embedded in the undersurface of the liver. Motor vehicle collision is the most common cause of blunt gallbladder injury. A thin gallbladder wall, distended gallbladder, and recent alcohol ingestion can predispose to gall bladder injury. Isolated gall bladder perforations are rare, and they are commonly associated with injuries of the liver, small bowel, spleen, kidney, pancreas, or abdominal vascular injury. They are challenging to diagnose due to vague symptoms of pain, and patients generally do not appear toxic on presentation. They present either during damage control surgery incidentally or with non-specific abdominal pain a few days after trauma. Conclusion: A gall bladder injury can be difficult to diagnose because of vague symptoms, and a high index of suspicion is required. Once diagnosed, an open or laparoscopic cholecystectomy is the definitive management.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Robert, Chris and Lay, Alicia, "Traumatic Rupture of Gall Bladder After Blunt Trauma" (2025). North Texas Research Forum 2025. 46.
https://scholarlycommons.hcahealthcare.com/northtexas2025/46