Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy): a case report and review of the literature

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.

Figure 1

Computed tomography (CT) scan reveals pericholecystic fluid (arrow) and indicates the potential for some kind of injury of the gallbladder.

Figure 2

Photographs of fixed gallbladder prepared with formaldehyde. (a) Successive sections of the gallbladder show traumatic hemorrhagic filtering. (b) Inverted gallbladder with the same findings.

Figure 3

Schematic drawing of all known types of gallbladder injury according to the classification by Losanoff and Kjossev [4]. Our case is highlighted.