Malek Mathew, Bjordahl Paul
University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
Sanford Health Trauma Services, Sioux Falls, South Dakota.
S D Med. 2020 Mar;73(3):102-105.
Gallbladder trauma is an uncommon occurrence, most commonly found incidentally at the time of laparotomy for associated injuries following abdominal trauma. It is even more rare in blunt abdominal trauma, with one of the rarest forms being an isolated injury to the gallbladder. Awareness for this type of injury should not be forgotten by emergency personal when evaluating someone with a history of recent trauma.
A 44-year-old male who works as a construction worker fell from a roof, landing on his right side. Upon evaluation by the emergency department, emergency personnel combined the history, abnormal laboratory values and imaging including ultrasound (U/S) and computed tomography (CT) to assess and diagnose a concern for gallbladder perforation. He was treated with a diagnostic laparoscopy, laparoscopic cholecystectomy, and intraoperative choleangiogram. The patient tolerated the procedure well and discharged home on postoperative day 1.
Gallbladder trauma can be seen in all population types. As the gallbladder is fairly protected, it is rare to have an isolated injury. A detailed history as described can tip off practitioners to the diagnosis, but is also missed or delayed due to occasionally vague symptoms. Imaging studies can be used adjunctively to assist in diagnosis and may include CT, U/S, color Doppler, or HIDA scans. These can also fail to give a diagnosis leading to a missed injury and further morbidity and mortality. Perforated gallbladders can safely be treated laparoscopically as well as other options depicted.
Awareness of isolated and rare injuries in trauma, such as those to the gallbladder, enables many types of emergency personnel to recognize and treat patients and consequently prevent the morbidity and mortality of a missed injury.
胆囊创伤并不常见，最常于腹部创伤后因相关损伤行剖腹手术时偶然发现。在钝性腹部创伤中更为罕见，最罕见的形式之一是胆囊孤立损伤。急诊人员在评估近期有创伤史的患者时，不应忽视对这类损伤的认识。
一名44岁男性建筑工人从屋顶坠落，右侧着地。经急诊科评估，急救人员综合病史、异常实验室检查值以及包括超声（U/S）和计算机断层扫描（CT）在内的影像学检查，以评估和诊断胆囊穿孔的可能性。患者接受了诊断性腹腔镜检查、腹腔镜胆囊切除术及术中胆管造影。患者对手术耐受良好，术后第1天出院。
各种人群均可发生胆囊创伤。由于胆囊受到相当程度的保护，孤立损伤较为罕见。所述详细病史可提示医生做出诊断，但偶尔因症状模糊也会被漏诊或延误。影像学检查可辅助诊断，可能包括CT、U/S、彩色多普勒或肝胆动态显像扫描。这些检查也可能无法做出诊断，导致漏诊损伤并进一步增加发病率和死亡率。穿孔胆囊可通过腹腔镜安全治疗，以及其他所描述的选择。
了解创伤中孤立且罕见的损伤，如胆囊损伤，能使各类急救人员识别并治疗患者，从而预防漏诊损伤导致的发病率和死亡率。
