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CASE REPORT
Year : 2016  |  Volume : 19  |  Issue : 2  |  Page : 301-302

Isolated gallbladder rupture following blunt abdominal injury


1 Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
2 Department of Nursing, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
3 Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Kaohsiung Medical University Hospital; Division of Hepatobiliary-Pancreatic Surgery, Transplantation Center, Kaohsiung Medical University Hospital; Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Date of Acceptance26-May-2015
Date of Web Publication9-Feb-2016

Correspondence Address:
Dr. S C Chuang
Department of Surgery, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 807
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1119-3077.164352

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   Abstract 

Isolated traumatic gallbladder rupture subsequent to blunt abdominal injury is rare. Most literatures on the subjects consist of case reports. We reported a rare case of isolated gallbladder rupture and discussed the possible predisposing factors to gallbladder rupture.

Keywords: Abdominal blunt injury, isolated gallbladder rupture, liver cirrhosis


How to cite this article:
Su H Y, Wu M C, Chuang S C. Isolated gallbladder rupture following blunt abdominal injury. Niger J Clin Pract 2016;19:301-2

How to cite this URL:
Su H Y, Wu M C, Chuang S C. Isolated gallbladder rupture following blunt abdominal injury. Niger J Clin Pract [serial online] 2016 [cited 2019 Nov 20];19:301-2. Available from: http://www.njcponline.com/text.asp?2016/19/2/301/164352


   Introduction Top


The gallbladder is a well-protected organ, being partially embedded in the liver and covered by the rib cage.[1] Consequently, trauma-related gallbladder rupture is rare, and usually associated with additional visceral injuries.[2] Isolated traumatic gallbladder rupture due to blunt abdominal trauma is even rarer. A retrospective review consisting of 1449 patients reported the incidence around 0.067%.[3] Here, we presented a case of isolated gallbladder rupture following a blunt abdominal injury.


   Case Report Top


A 39-year-old man with history of cholelithiasis, alcoholism-related liver cirrhosis, and chronic pancreatitis presented to our emergency room (ER) due to being hurt with a blow from a fist on the right upper abdomen 3 h before coming to our ER. At arrival, the vital signs were heart rate 131 beats/min, respiratory rate 34 times/min, and blood pressure 52/29 mmHg. Physical examination showed ecchymosis with size 4 cm × 5 cm over the right hypochondrial region. Besides, diffused muscle guarding and rebound tenderness were also present. Laboratory examination showed white blood cell count 9620/µl, hemoglobin 7.6 g/dL, glutamate oxaloacetate transaminase 155 µ/L, glutamate pyruvate transaminase 84 µ/L, total bilirubin 0.91 mg/dL, direct bilirubin 0.39 mg/dL, prothrombin time 18.5 s (control 10.9 s), partial thromboplastin time 36.3 s (control 27.8 s), amylase 29 µ/L, and lipase 3.8 µ/L. Abdominal computed tomogram showed interrupted gallbladder wall with peripheral hematoma, hemoperitoneum, spillage of gallbladder stones and cirrhosis [Figure 1]a. Exploratory laparotomy was arranged after adequate resuscitation. A perforation with length about 3 cm at the fundus and body of the gallbladder was found [Figure 1]b. Besides, we also found spillage of gallbladder stones and uneven surface of the liver. A cholecystectomy was performed, and no other visceral injury was noted. Postoperative course was uneventful. This patient was discharged on the 9th postoperative day. There was no abdominal discomfort noted at the out-patient department follow-up subsequently. The histology report of the gallbladder presented chronic cholecystitis.
Figure 1: (a) Abdominal computed tomogram showing interrupted gallbladder wall (arrow) with a peri-cholecystic hematoma (arrowhead). (b) Perforation at the fundus and body of the gallbladder and intra-gallbladder hematoma (arrow), liver cirrhosis with uneven surface (arrowhead)

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   Discussion Top


Smith and Soderberg noticed three factors predisposing the gallbladder to rupture, secondary to abdominal blunt trauma.[4] First, a thin-walled normal gallbladder is more prone to rupture. The fibrotic, thickened wall of the chronically inflamed gallbladder probably makes it less prone to rupture. The second factor is the degree of filling at the time of trauma. It is postulated that gallbladder distention at the time of trauma is a prerequisite for its rupture. The third factor contributing to gallbladder rupture is alcohol ingestion. A high incidence of traumatic gallbladder rupture is reported in alcohol-intoxicated patients. Alcohol intake enhances gastrin and secretin secretions, which in turn stimulate bile flow, and high serum of alcohol elevates the common bile duct pressure by increasing the  Sphincter of Oddi More Details's tone.[2],[3],[4]

In our case, he ate nothing 7 h before the injury which resulted in dilatation of gallbladder before he got injured. Besides, he was a patient with a past history of chronic pancreatitis and liver cirrhosis related to alcoholism. Increased pressure of sphincter of Oddi related to alcohol consumption was taken into account.

Besides, the gallbladder is close to the liver, which is a firm organ supplying cushion when encountering shearing acceleration-deceleration force. In contrast, a gallbladder is put on a hard block when the patient has a cirrhotic liver. Considering the difference in mass between the gallbladder and liver, it would seem reasonable to postulate that exposure to acceleration and deceleration forces could result in shearing forces between these two organs.[3] In conclusion, we reported a rare case of isolated gallbladder rupture and advocated the 4th predisposing factors to gallbladder rupture.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Gali BM, Ali N, Bakari AA, Suleiman IE. Isolated gallbladder rupture following blunt abdominal trauma. Niger J Clin Pract 2013;16:398-400.  Back to cited text no. 1
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2.
Schachter P, Czerniak A, Shemesh E, Avigad I, Lotan G, Wolfstein I. Isolated gallbladder rupture due to blunt abdominal trauma. HPB Surg 1989;1:359-62.  Back to cited text no. 2
    
3.
Soderstrom CA, Maekawa K, DuPriest RW Jr, Cowley RA. Gallbladder injuries resulting from blunt abdominal trauma: An experience and review. Ann Surg 1981;193:60-6.  Back to cited text no. 3
    
4.
Machado MA, Volpe P, Zantut LF, Dario Birolini RS. Traumatic injuries of the gallbladder: Report on 32 cases. Panam J Trauma 1995;5:20-5.  Back to cited text no. 4
    


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