Gallbladder Injury Research Articles

Ruptured Gall Bladder containing Stones following Blunt Trauma Abdomen: A Rare Presentation of Hemodynamic Instability

Gall bladder injuries are seen in 2% of patients undergoing laparotomy for blunt trauma abdomen. Isolated gall bladder injury is a rare event with associated presence of stones is even rarer. The associated visceral injuries lead to intraoperative identification in most cases. Here we present a case of 30 years old male with isolated gall bladder laceration following blunt abdominal trauma. The diagnosis of gallbladder perforation after blunt injury may be suspected in patients with signs of an acute abdomen and hypotension that is not explained by blood loss. Early suspicion and prompt exploration is imperative. Cholecystectomy is an adequate treatment for the condition.

Isolated gallbladder hematoma after a blunt abdominal trauma: case report

Background Sonography has played an important role on detection of intraabdominal injuries with a sensitivity of 86%, a specificity of 98%, and an accuracy of 97% [1]. Negative predictive value achieved about 98% [1]. However, gallbladder injury is rare with incidence around 2.1% [2,3] in blunt abdominal trauma [2], and commonly associated with the solid organ injury or abdominal vascular injury [4]. Isolated gallbladder injury were very few[3] including traumatic cholecystitis, gallbladder tear, and gallbladder perforation ...etc. Ultrasound is very sensitive to gallbladder disease. We presented a rare case of isolated gallbladder hematoma after a blunt abdominal trauma which diagnosis by Focused Gallbladder ultrasound.

Role of ERCP in pediatric blunt abdominal trauma: A case series at a level one pediatric trauma center

BackgroundThere is no consensus regarding the appropriate use of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric trauma. We report our experience with ERCP for management of pediatric pancreatic and biliary injury following blunt abdominal trauma. MethodsA retrospective chart review was performed for pediatric patients with blunt abdominal trauma from July 2008 through December 2012 at our pediatric trauma center. For patients who underwent ERCP, demographics, injury characteristics, diagnostic details, procedures performed, length of stay, total parenteral nutrition use, and complications were reviewed. ResultsThere were 532 patients identified: 115 hepatic injuries, 25 pancreatic injuries and one gall bladder injury. Nine patients (mean age 7.8 years) underwent ERCP. Seven (78%) had pancreatic injuries, while two (22%) had bilateral hepatic duct injuries. The median time to diagnosis was one day (range, 0-12). Diagnostic ERCP only was performed in three patients, two of which proceeded to distal pancreatectomy. Five patients had stents placed (two biliary and three pancreatic) and four sphincterotomies were performed. Despite pancreatic stenting, one patient required distal pancreatectomy for persistent leak. Median length of stay was 11 days. ConclusionsPediatric pancreatic and biliary ductal injuries following blunt abdominal trauma are uncommon. ERCP can safely provide definitive treatment for some patients.

Isolated gallbladder perforation following blunt abdominal trauma.

A 32-year-old man sustained an isolated perforation of the gallbladder following blunt abdominal trauma. A preoperative diagnosis was made on an ultrasound scan, which showed a pericholecystic fluid collection only. At laparotomy, a gallbladder perforation at the infundibulum was identified with a localised bile collection, warranting a cholecystectomy. Isolated gallbladder injury from blunt abdominal trauma is rare, and a high index of suspicion is required to establish the diagnosis. Cholecystectomy is the treatment of choice.

Gastrointestinal system complications in percutaneous nephrolithotomy: a systematic review.

To evaluate gastrointestinal tract complications of percutaneous nephrolithotomy (PCNL), to determine risk factors, and to develop strategies for diagnosis and treatment. A literature review was conducted for the studies published in the English language in the databases of PubMed and Scopus between July 1985 and June 2013. The key words for digital literature search were limited to the following: "percutaneous nephrolithotomy complications, ([splenic injury, liver injury, gallbladder injury and biliary peritonitis, colonic injury] during/after [percutaneous nephrolithotomy]), complication, Clavien, Clavien-Dindo classification, management, review, PNL, PCNL." A total of 16 articles on splenic injury were reviewed. There was no consensus in the literature regarding the management of splenic injuries. A conservative approach with new treatment modalities is the most widely accepted method in the literature. A total of seven articles on gallbladder injury were reviewed. All gallbladder injuries resulted in cholecystectomy. The time of diagnosis is the most significant parameter determining choice between laparoscopy and laparotomy. A total of seven articles on liver injury were reviewed. The liver injury generally provides the best response to a conservative approach among other solid organ injuries. A total of 11 articles on bowel injury were reviewed. Bowel injury mostly results in exploratory laparotomy. Unlike colon injuries, bowel injuries are more complex to manage with conservative measures because of the challenges in diagnosis and the fact that the injury is located in the intraperitoneal area. A total of 28 articles, which comprised a large case series with colon injuries, consisted of collaborative reviews and meta-analyses were reviewed. In total, 51 colon injuries (0.5%) were evaluated occurring in 13,424 patients in supine and prone PCNL series. Conservative approaches have proven to be effective in colon injuries in the absence of large perforations and intraperitoneal involvement. There is a downward trend in gastrointestinal complications from PCNL because of the technologic advances that guide the diagnosis and treatment. Paradoxically, the rate of complications is higher in complex kidney stones such as those in a horseshoe kidney and pelvic and malrotated kidney that represent anatomic challenges for intervention. The most important point is to determine the risk factors for preoperative planning of the procedure and to diagnose the complications for proper management early.

Isolated gallbladder perforation after trivial abdominal trauma in a child: a case report and review of the literature

Gallbladder injury after blunt abdominal trauma is rare. Isolated gall bladder perforation due to blunt abdominal trauma is even rarer. The clinical presentation of gallbladder injury is variable resulting in delay in diagnosis and treatment .Early diagnosis is thus essential but still remains a challenge. We present a case of 12 year old child with isolated gall bladder perforation following trivial blunt trauma to the abdomen.

外傷性胆嚢単独損傷の1例

外傷性胆嚢単独損傷の1例

Tissue Factor and Tissue Factor Pathway Inhibitor in Chronically Inflamed Gallbladder Mucosa

We characterised a tissue factor (TF) and tissue factor pathway inhibitor (TFPI) expression in relation to severity of inflammatory infiltration of the gallbladder mucosa in a chronic cholecystitis. We prospectively studied the gallbladder specimens obtained from 54 patients who had undergone cholecystectomy due to chronic calculous cholecystitis and 16 calculosis-free gallbladder specimens obtained from patients who underwent cholecystectomy due to the polyp/polyps as well as in cases of gallbladder injury. To assess TF and TFPI immunoreactivity by immunohistochemistry, the monoclonal anti-human TF and TFPI antibodies were used. The inflammatory infiltration of the gallbladder mucosa was reflected by the number of CD3 and CD68 positive cells. The expression of TF and TFPI differed significantly between the cholecystitis and the control group. Most capillary endothelial cells of the cholecystitis group presented weak expression for TFPI. The mean number of CD3 positive lymphocytes in the cholecystitis group was 18.6 ± 12.2, but the mean number of CD68 positive cells was 29.7 ± 13.9. In the control sections, it was 3.1 ± 1.9 and 8.8 ± 3.9, respectively (P < 0.001). The results of the current study suggest that the tissue procoagulant state found may be engaged in the etiopathogenesis of the cholecystitis.

Treatment and outcome of traumatic biliary injuries in children

Background/PurposeTraumatic biliary tract injuries in children are rare but may result in significant morbidity. The objective of this study was to review the occurrence of traumatic biliary tract injuries in children, management strategies, and outcome. MethodsWe conducted a retrospective review of patients with biliary tract injury using the trauma registry at our level 1 pediatric trauma center from 2002–2012. ResultsTwelve out of 13,582 trauma patients were identified, representing 0.09% of all trauma patients. All were secondary to blunt trauma. Mean age was 9.7years [range 4–15], and mean Injury Severity Score was 31±14, with overall survival of 92%. Biliary injuries included major ductal injury (6), minor ductal injury with biloma (4), gallbladder injury (2), and intrahepatic ductal injury (1). Major ductal injuries were managed by endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent (5) and Roux-en-Y hepaticojejunostomy (1). Associated gallbladder injury was managed by cholecystectomy. In addition, the associated biloma was managed with percutaneous drainage (7), laparoscopic drainage (2), or during laparotomy (3). Two patients with ductal injuries developed late strictures after initial management with ERCP and stent placement. One of the two patients ultimately required a left hepatectomy, and the other has been managed conservatively without evidence of cholangitis. Two patients required placement of additional drains and prolonged antibiotics for superinfection following biloma drainage. ConclusionBiliary tract injuries are rare in children, and many are amenable to adjunctive therapy, including ERCP and biliary stent placement with or without placement of a peritoneal drain. Patients with a discrete ductal injury are at higher risk for stricture and require close follow up. Hepaticojejunostomy remains the definitive repair for large extrahepatic biliary tract injuries or transections.

Isolated rupture of the gallbladder following blunt abdominal trauma: case report

ABSTRACTGallbladder rupture following blunt abdominal trauma is a rare event recognized on evaluation and treatment of other visceral injuries during laparotomy. Isolated gallbladder rupture secondary to blunt abdominal trauma is even more uncommon. The clinical presentation of gallbladder injury is variable, resulting in a delay in diagnosis and treatment. We report the case of a patient who suffered an isolated gallbladder rupture due to blunt abdominal trauma.

Fatal intra-abdominal hemorrhage as a result of avulsion of the gallbladder: A postmortem case report

Gallbladder injuries are extremely rare in blunt trauma, with a reported incidence of <2%. We report an autopsy case of fatal hemorrhagic shock due to intra-abdominal bleeding resulting from complete avulsion of the gallbladder associated with liver cirrhosis. Multiplanar images derived from multislice computed tomography (MSCT) performed as part of pre-autopsy screening showed complete avulsion of the gallbladder without any other associated intra-abdominal injuries, facilitating forensic autopsy planning. In this report, we discuss the role of MSCT in cases of fatal intra-abdominal bleeding caused by avulsion of the gallbladder and discuss the mechanism of this injury.

Cystic Artery Bleeding due to Blunt Gallbladder Injury Treated with Transcatheteral Arterial Embolization

Cystic Artery Bleeding due to Blunt Gallbladder Injury Treated with Transcatheteral Arterial Embolization

Management of blunt and penetrating biliary tract trauma

Penetrating or blunt injury to the biliary tree remains a rare complication of trauma occurring in 0.1% of trauma admissions. Because of the different presentations, sites of biliary tract injury, and associated organ injury, there are many possible management pathways to be considered. A retrospective analysis of prospectively gathered data was performed for all gallbladder and biliary tract injuries presenting to the trauma service or hepatobiliary unit of the Royal Melbourne Hospital between January 1, 1999, and March 30, 2011. There were 33 biliary injuries in 30 patients (0.1%) among 26,014 trauma admissions. Three of the 30 patients (10%) died. Of 10 gallbladder injuries, 8 were managed with cholecystectomy. There were 23 injuries to the biliary tree. Fourteen patients had injuries to the intrahepatic biliary tree of which seven involved segmental ducts. Of these, four segmental duct injuries required hepatic resection or debridement. Nine patients had injury to the extrahepatic biliary tree of which five required T-tube placement ± bilioenteric anastomosis and one a pancreaticoduodenectomy. Biliary injury is a rare but important consequence of abdominal trauma, and good outcomes are possible when a major trauma center and hepatopancreaticobiliary service coexist. Cholecystectomy remains the gold standard for gallbladder injury. Drainage with or without endoscopic stenting will resolve the majority of intrahepatic and partial biliary injuries. Hepaticojejunostomy remains the gold standard for complete extrahepatic biliary disruption. Hepatic and pancreatic resection are only required in the circumstances of unreconstructable biliary injury. Therapeutic study, level V.

Laparoscopic cholecystectomy for traumatic gallbladder perforation.

In trauma, laparoscopic surgery is commonly utilized as a diagnostic rather than therapeutic measure (1). Its use is often negated because of exigency or limitations in visibility due to haemorrhage. In the present case, a 35-year-old male was involved in a motor vehicle collision and arrived haemodynamically stable with abdominal pain. Abdominal CT revealed liver laceration and active contrast extravasation near the gallbladder fossa. Although angiography with embolization would normally be used, exploratory laparoscopy was performed because of concern for gallbladder injury. The gallbladder was found to be perforated and nearly completely avulsed from the fossa. Laparoscopic cholecystectomy was performed and the patient recovered uneventfully. Gallbladder perforation after trauma is typically an incidental finding during operation for haemorrhagic shock or other indication. Early diagnosis and swift surgical intervention are required, usually via laparotomy. However, when diagnosed preoperatively in the stable trauma victim, gallbladder perforation can be treated successfully with laparoscopy.

Isolated Gallbladder Injury in a Case of Blunt Abdominal Trauma

The diagnosis of blunt injury to the gallbladder may constitute a significant challenge to the diagnostician. There is often a delay in presentation with non-specific clinical symptoms. In the absence of reliable clinical symptoms, diagnostic imaging becomes an invaluable tool in the rapid identification of gallbladder injury. We present a case of isolated gallbladder injury following blunt abdominal trauma which was diagnosed by computed tomography and subsequently confirmed by cholecystectomy.

Gallbladder Needle Decompression During Radiofrequency Ablation of an Adjacent Liver Tumour

Gallbladder perforation with bile leak can result from thermal injury during radiofrequency ablation of liver tumours. Two case studies demonstrate a technique for preventing gallbladder injury to the peritoneal surface of a distended gallbladder adjacent to the anticipated hepatic ablation zone. The use of percutaneous gallbladder needle decompression can safely separate or retract the peritoneal surface of the gallbladder from a contiguous hepatic radiofrequency ablation zone.

Isolated Gall Bladder Perforation Following a Blunt Injury in the Abdomen

Gall bladder injuries which are caused after a blunt trauma in the abdomen are rare and they have significant mortality and morbidity when the treatment is delayed. They usually go undiagnosed until an exploratory laparotomy is done. We are reporting here a case of isolated gall bladder neck perforation, which is an uncommon finding following a blunt injury in the abdomen.

A Case Report of Gallbladder Injury Resulting from an Alcohol-Related Fall

A Case Report of Gallbladder Injury Resulting from an Alcohol-Related Fall

Blunt Abdominal Trauma Resulting in Gallbladder Injury: A Review With Emphasis On Pediatrics

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. Literature searches were performed using Pubmed and Medline with keywords "abdominal trauma," "gallbladder injury," and "gallbladder perforation." 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.

Cholecystitis and Cholelithiasis Associated with an Intramural Fasciitis-Like Proliferation and Osseous Metaplasia

Fasciitis-like proliferations are said to be uncommon in the viscera; a fasciitis-like pattern of gallbladder injury may not be rare, but to our knowledge it has not been explicitly reported as such in any age group. Osseous metaplasia, or heterotopic bone, in the gallbladder is rare and has not to our knowledge been reported in a pediatric patient. We report a 7-year-old boy with sickle cell disease who presented with right upper quadrant abdominal pain. An ultrasonograph demonstrated a dilated common bile duct with sludge and stones. A cholecystectomy was performed. Grossly the gallbladder showed numerous pigmented choleliths, and histologically there was cholecystitis with a fasciitis-like fibrous proliferation containing scattered osteoclast-like giant cells and an area of osseous metaplasia. This report, describing a pattern that could be termed "cholecystitis ossificans," expands the histologic spectrum of chronic cholecystitis, a common disease with a poorly understood pathogenesis.