Jaggard Matthew K J, Johal Navroop S, Choudhry Muhammad
Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom.
J Trauma. 2011 Apr;70(4):1005-10. doi: 10.1097/TA.0b013e3181fcfa17.
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.
钝性腹部创伤中的胆囊损伤是一种罕见且难以诊断的疾病。据报道，胆囊损伤在所有腹部创伤中占1.9%至2.1%。其症状模糊，检查结果通常不明确；因此，常在剖腹手术时才得以诊断。患者通常有模糊的腹痛，偶尔会根据胆囊损伤的类型出现一段缓解期。在儿科，钝性腹部创伤还存在病史询问困难和生理代偿等额外挑战。诊断和确定性治疗的任何延迟都会使预后恶化。做出诊断需要敏锐的临床洞察力和影像学解读能力。洛萨诺夫的分类系统在指导治疗方面具有价值。虽然胆囊切除术是首选治疗方法，但也有一些情况下胆囊可保留原位，本文对此进行了讨论。
使用PubMed和Medline以“腹部创伤”、“胆囊损伤”和“胆囊穿孔”为关键词进行文献检索。
作者强调了胆囊创伤中合并内脏损伤的发生率（>90%）。在损伤时胆囊扩张且壁薄的情况下，胆囊穿孔的可能性更大。因此，我们建议对近期饮酒或进食的患者怀疑有胆囊穿孔。尽管现代计算机断层扫描技术有所发展，但由于这种情况的细微性和罕见性，识别胆囊穿孔仍很困难。我们提请注意所提出的解剖学分类系统，因为它们在指导治疗方面有一定用途。在钝性腹部创伤后未明确诊断且腹腔内有游离液体时，临床医生面临着是否因潜在的内脏损伤而进行手术的艰难决策。在讨论了现有证据后，作者主张对进行诊断性腹腔镜检查持较低的怀疑指数。
