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Pham HD, Nguyen TC, Huynh QH. Diagnostic imaging in a patient with an isolated blunt traumatic gallbladder injury. Radiol Case Rep 2021; 16:2557-2563. [PMID: 34306287 PMCID: PMC8283152 DOI: 10.1016/j.radcr.2021.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 12/08/2022] Open
Abstract
Isolated gallbladder injuries are very uncommon in blunt abdominal trauma due to its small size. Further, they are well protected by the surrounding liver, omentum, and the rib cage. A case of traumatic gallbladder injury in a 47-year-old man with progressive right hypochondrial pain is presented. The gallbladder injury was caused due to a blunt abdominal trauma after a motor vehicle accident. The patient had a history of chronic alcoholism and narcotics abuse. The patient was also human immunodeficiency virus-positive and was on stable treatment for tuberculosis. A diagnosis of gallbladder contusion with intramural dissection was made after an ultrasound and computed tomography scan. However, the patient refused surgery and thus, an ultrasound-guided percutaneous transhepatic drainage of the gallbladder was performed as a temporary treatment. Subsequently, a successful cholecystectomy was performed. Isolated traumatic gallbladder injury has been reviewed due to the rarity of this condition and the diagnostic challenges it poses.
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Affiliation(s)
- Hong Duc Pham
- Radiology Department, Ha Noi Medical University, Ha Noi, Vietnam.,Radiology Department, Saint-Paul Hospital, Ha Noi, Vietnam
| | | | - Quang Huy Huynh
- Radiology Department, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung street, District 10, Ho Chi Minh city 700000, Vietnam.,Radiology Department, Trung Vuong Hospital, Ho Chi Minh city, Vietnam
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Pavlidis TE, Lalountas MA, Psarras K, Symeonidis NG, Tsitlakidis A, Pavlidis ET, Ballas K, Flaris N, Marakis GN, Sakantamis AK. Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy): a case report and review of the literature. J Med Case Rep 2011; 5:392. [PMID: 21851630 PMCID: PMC3169498 DOI: 10.1186/1752-1947-5-392] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 08/18/2011] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Injury of the gallbladder after blunt abdominal trauma is an unusual finding; the reported incidence is less than 2%. Three groups of injuries are described: simple contusion, laceration, and avulsion, the last of which can be partial, complete, or total traumatic cholecystectomy. CASE PRESENTATION A case of isolated complete avulsion of the gallbladder (near traumatic cholecystectomy) from its hepatic bed in a 46-year-old Caucasian man without any other sign of injury is presented. The avulsion was due to blunt abdominal trauma after a car accident. The rarity of this injury and the stable condition of our patient at the initial presentation warrant a description. The diagnosis was made incidentally after a computed tomography scan, and our patient was treated successfully with ligation of the cystic duct and artery, removal of the gallbladder, coagulation of the bleeding points, and placement of a drain. CONCLUSIONS Early diagnosis of such injuries is quite difficult because abdominal signs are poor, non-specific, or even absent. Therefore, a computed tomography scan should be performed when the mechanism of injury is indicated.
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Affiliation(s)
- Theodoros E Pavlidis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Miltiadis A Lalountas
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Kyriakos Psarras
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Nikolaos G Symeonidis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Anastasios Tsitlakidis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Efstathios T Pavlidis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Konstantinos Ballas
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Nikolaos Flaris
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Georgios N Marakis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Athanassios K Sakantamis
- Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
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Blunt abdominal trauma resulting in gallbladder injury: a review with emphasis on pediatrics. ACTA ACUST UNITED AC 2011; 70:1005-10. [PMID: 21610404 DOI: 10.1097/ta.0b013e3181fcfa17] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Gallbladder injury in blunt abdominal trauma is a rare and difficult diagnosis. Gallbladder injury is reported to be between 1.9% and 2.1% of all abdominal traumas. It has vague symptoms usually with inconclusive investigation results; hence, it is often diagnosed at laparotomy. The patient typically has vague abdominal pain and occasionally a period of remission depending on the type of gallbladder injury. In pediatrics, blunt abdominal trauma presents additional challenges of difficult historians and compensating physiology. Any delay in diagnosis and definitive management will worsen the prognosis. Making the diagnosis requires astute clinical acumen and radiologic interpretation. The classification system of Losanoff has merit in guiding treatment. While cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ and these are discussed. METHODS Literature searches were performed using Pubmed and Medline with keywords "abdominal trauma," "gallbladder injury," and "gallbladder perforation." DISCUSSION The authors highlight the incidence of associated visceral injuries in gallbladder trauma (>90%). Gallbladder perforation is more likely in cases when the gallbladder is distended and thin-walled at the time of injury. Therefore, we recommend that gallbladder perforation is suspected in those patients who have drunk alcohol or eaten recently. Despite the developments in modern computed tomography, identifying gallbladder perforation is difficult because of the subtlety and rarity of the condition. We draw attention to the proposed anatomic classification systems because they are of some use in guiding treatment. In the absence of a diagnosis after blunt abdominal trauma and with intra-abdominal free fluid, the clinician faces the difficult decision of whether surgery is indicated for a potential visceral injury. After discussing the available evidence, the authors advocate a low index of suspicion for performing diagnostic laparoscopy.
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Leppäniemi A, Lamminen A, Tervahartiala P, Salo J, Haapiainen R, Lehtonen T. MRI and CT in blunt renal trauma: an update. Semin Ultrasound CT MR 1997; 18:129-35. [PMID: 9163832 DOI: 10.1016/s0887-2171(97)90057-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In our experience, MRI is as effective as CT in correctly staging renal injury. The coronal and sagittal slice orientations of MRI are particularly helpful in determining the extent of the renal parenchymal damage. Both methods are accurate in finding perirenal hematomas, assessing the viability of renal fragments, and detecting preexisting renal abnormalities but are relatively inaccurate in visualizing urinary extravasation. Although CT remains the method of choice in radiological staging of renal injury, MRI can complement CT in patients with severe renal injury, preexisting renal abnormality, equivocal CT findings, or when repeated radiological follow-up is required. MRI could replace CT in patients with iodine allergy and be used for initial staging if CT is not available.
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Affiliation(s)
- A Leppäniemi
- Second Department of Surgery, Helsinki University Central Hospital, Finland
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Leppäniemi A, Lamminen A, Tervahartiala P, Haapiainen R, Lehtonen T. Comparison of high-field magnetic resonance imaging with computed tomography in the evaluation of blunt renal trauma. THE JOURNAL OF TRAUMA 1995; 38:420-7. [PMID: 7897731 DOI: 10.1097/00005373-199503000-00025] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To compare magnetic resonance (MR) imaging and computed tomography (CT) in radiographic staging of blunt renal trauma. DESIGN A prospective study. MATERIALS AND METHODS Fourteen patients with blunt renal trauma not requiring early surgical treatment underwent CT, and high-field (1.0 T) MR imaging. MEASUREMENTS AND MAIN RESULTS MR imaging equaled CT in correctly grading the renal injury. The coronal and sagittal projections of MR imaging were helpful in determining the extent of the renal parenchymal lesion. Both methods were accurate in finding perirenal hematomas, assessing the viability of renal fragments, and detecting pre-existing renal abnormalities, but failed to visualize urinary extravasation on initial examination. CONCLUSIONS Although CT remains the method of choice in radiographic staging of renal injury, MR imaging can complement CT in patients with severe renal injury, pre-existing renal abnormality, equivocal CT findings, or when repeated radiographic follow-up is required. MR imaging could replace CT in patients with iodine allergy and be used for initial staging if CT is not available.
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Affiliation(s)
- A Leppäniemi
- Second Department of Surgery, Helsinki University Central Hospital, Finland
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Leppäniemi AK, Kivisaari AO, Haapiainen RK, Lehtonen TA. Role of magnetic resonance imaging in blunt renal parenchymal trauma. BRITISH JOURNAL OF UROLOGY 1991; 68:355-60. [PMID: 1933153 DOI: 10.1111/j.1464-410x.1991.tb15349.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The accuracy of magnetic resonance imaging (MRI) in the evaluation of blunt renal parenchymal trauma was compared with that of contrast-enhanced computed tomography (CT) and ultrasonography (US) in a prospective study of 12 patients. CT was superior to other methods in identifying and characterising the renal parenchymal lesion, and both CT and US exceeded low field MRI in recognising a perirenal fluid collection. The role of high field MRI in the evaluation of blunt renal trauma requires further study.
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Affiliation(s)
- A K Leppäniemi
- Second Department of Surgery, Helsinki University Central Hospital, Finland
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