GALLBLADDER RUPTURE DUE TO BLUNT TRAUMA: A CASE REPORT marina.tanit2002@gmail.com

PE109

GALLBLADDER RUPTURE DUE TO BLUNT TRAUMA: A CASE REPORT

4

Mexico

Poster with Discussion

Isolated gallbladder injury (IGBI) after blunt abdominal trauma is extremely rare, with an incidence of <0.01%. Bell et al. reported only 45 cases among 40,000 trauma admissions. Due to its anatomical position, the gallbladder is usually protected by surrounding viscera. Commonly, it results from high-energy deceleration trauma, such as motor vehicle collisions. Penn’s classification (1966) defines grade III as traumatic perforation and grade IV as complete avulsion. Diagnosis is challenging; <18% of cases are identified by CT, and most are discovered intraoperatively. Cholecystectomy is the treatment of choice.

A 57-year-old male, non-diabetic, non-hypertensive, presented after a car accident as the driver, under alcohol influence. He underwent standard trauma protocol: clinical assessment, lab work, chest X-ray, and abdominal CT. Due to hemodynamic instability and presence of free peritoneal fluid, exploratory laparotomy was performed.

Physical exam: tachycardia, normotension, abdominal tenderness without rebound, left thoracic pain. Labs: Leukocytosis (21.6 x10⁹/L), lactate (4.3 mmol/L), Cr (2.1 mg/dL), AST (362), ALT (179). Imaging: Rib fractures (5th–8th), perihepatic free fluid. Surgery: Grade IV gallbladder rupture (total avulsion, absent fundus), no bile leak, no other intra-abdominal injuries. Treated with open cholecystectomy.

Isolated gallbladder rupture due to blunt trauma is rare and difficult to diagnose, particularly in early stages. CT has low sensitivity; most diagnoses are intraoperative. Clinical suspicion should remain high, especially in male patients with alcohol intake and upper abdominal trauma. Early surgical intervention ensures good outcomes.