Scaglione M, Rossi G, Pinto F, Forner A L, Giovine S, Pinto A, Vicenzo E, Romano L
Dipartimento di Emergenza, Azienda Ospedaliera A. Cardarelli, Napoli.
Radiol Med. 1998 Dec;96(6):592-5.
To assess the diagnostic accuracy and the possible role of ultrasonography (US) and Computed Tomography (CT) in a small group of patients who had a blunt abdominal trauma involving the gallbladder.
We retrospectively reviewed the US and CT findings of five patients with surgically confirmed post-traumatic gallbladder injury. The whole series consisted of 196 consecutive patients submitted to laparotomy for blunt abdominal trauma in the past 7 years. The following US and CT findings were considered at least suggestive of a possible post-traumatic gallbladder injury: pericholecystic fluid collection, ill-defined wall margin, collapsed lumen, high intraluminal density.
At surgery, the following findings were observed: gallbladder hematoma (1 case), acute colecystitis (1 cases), gallbladder tear (3 cases), gallbladder tear associated with post-traumatic hepatic injuries (2 cases), duodenal tear (2 cases), hemoperitoneum alone (2 cases), hemoperitoneum associated with choleperitoneum (1 case), choleperitoneum alone (1 case). The US and CT findings were pericholecystic fluid collections (4 cases), ill-defined gallbladder wall margins (3 cases), collapsed lumen with intraluminal high density (1 case) and free intraperitoneal fluid collections (4 cases). They were suggestive of a possible post-traumatic gallbladder injury in all the five patients.
The radiologic findings of our five patients were suggestive of a gallbladder damage but did not permit to distinguish minor from major injuries, the latter requiring surgical treatment. US proves to be a useful screening tool which can also help timing surgery in these patients. CT confirmed the US suspicions and also permitted accurate assessment of associated post-traumatic injuries to the liver and duodenum. Nevertheless, the clinical presentation was the most important factor as to the therapeutic management of these blunt abdominal trauma patients.
评估超声（US）和计算机断层扫描（CT）在一小部分遭受涉及胆囊的钝性腹部创伤患者中的诊断准确性及可能作用。
我们回顾性分析了5例经手术证实的创伤后胆囊损伤患者的超声和CT检查结果。整个系列包括过去7年中因钝性腹部创伤接受剖腹手术的196例连续患者。以下超声和CT表现被认为至少提示可能存在创伤后胆囊损伤：胆囊周围积液、边界不清的胆囊壁、胆囊腔萎陷、腔内高密度。
手术中观察到以下情况：胆囊血肿（1例）、急性胆囊炎（1例）、胆囊撕裂（3例）、与创伤后肝损伤相关的胆囊撕裂（2例）、十二指肠撕裂（2例）、单纯腹腔积血（2例）、与胆汁性腹膜炎相关的腹腔积血（1例）、单纯胆汁性腹膜炎（1例）。超声和CT表现为胆囊周围积液（4例）、胆囊壁边界不清（3例）、胆囊腔萎陷伴腔内高密度（1例）和腹腔内游离积液（4例）。这些表现提示所有5例患者可能存在创伤后胆囊损伤。
我们5例患者的影像学表现提示胆囊损伤，但无法区分轻伤和重伤，后者需要手术治疗。超声被证明是一种有用的筛查工具，也有助于确定这些患者的手术时机。CT证实了超声的怀疑，还能准确评估肝脏和十二指肠的相关创伤后损伤。然而，临床表现对于这些钝性腹部创伤患者的治疗管理是最重要的因素。
