Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Paediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Rofo. 2021 Aug;193(8):889-897. doi: 10.1055/a-1339-1904. Epub 2021 Feb 3.
Gallbladder perforation is a very rare finding in children. Clinical and radiografic presentations are often vague. Hence it is a challenging diagnosis, often missed during initial evaluation with potentially fatal consequences. The aim of this case report and review was to identify factors that might help to diagnose and manage future cases.
We present a case of gallbladder perforation in an 8-year-old child after blunt abdominal trauma caused by a handlebar in which imaging modalities such as ultrasound and magnetic resonance imaging (MRI) helped us to determine proper management. We identified and evaluated comparable cases for isolated traumatic gallbladder injury. A review of the recent literature was performed by online search in Pubmed and Google Scholar using "gallbladder injury in children", "gallbladder perforation children", "blunt abdominal trauma children" as keywords. We focused on articles exclusively in the pediatric section. The literature from the period 2000-2020 was taken into account to review the state of the art in diagnosis and management.
Recent literature for gallbladder injury in pediatrics is sparse compared to the adult counterpart. Only eight published cases of isolated gallbladder injury in children were identified. Since the onset of symptoms may not develop acutely and often develops in an indistinct manner, radiografic examinations play an important role in the diagnostic progress. The authors advise caution in cases of blunt abdominal trauma especially involving handlebars, intraperitoneal free fluid, and severe abdominal pain. We advocate high suspicion of gallbladder perforation if the gallbladder wall displays discontinuation or cannot be definitively differentiated in sonografic examination. Echogenic fluid within the gallbladder should always lead to suspicion of intraluminal bleeding. Repeated clinical and imaging examinations are mandatory since the onset of signs and symptoms may be delayed.
· Awareness of gallbladder perforation in blunt abdominal trauma of the upper abdomen.. · Particularly high index of suspicion in cases involving handlebar injuries.. · Repeated clinical and imaging examinations are highly recommended..
· Le MT, Herrmann J, Groth M et al. Traumatic Gallbladder Perforation in Children - Case Report and Review. Fortschr Röntgenstr 2021; 193: 889 - 897.
胆囊穿孔在儿童中非常罕见。临床表现和影像学表现通常较为模糊。因此，这是一种具有挑战性的诊断，在初次评估中经常被遗漏，可能导致致命后果。本病例报告和综述的目的是确定有助于诊断和管理未来病例的因素。
我们报告了一例 8 岁儿童在腹部钝性创伤后发生胆囊穿孔的病例，其中超声和磁共振成像（MRI）等影像学检查有助于确定适当的治疗方法。我们确定并评估了可比的孤立性外伤性胆囊损伤病例。通过在 Pubmed 和 Google Scholar 上在线搜索“儿童胆囊损伤”、“儿童胆囊穿孔”、“儿童腹部钝性创伤”等关键词，对近期文献进行了综述。我们重点关注儿科部分的文章。考虑到 2000 年至 2020 年期间的文献，综述了诊断和治疗的最新进展。
与成人相比，儿科胆囊损伤的文献相对较少。仅确定了 8 例儿童孤立性胆囊损伤的已发表病例。由于症状的发作可能不会急性发展，并且通常以不明显的方式发展，影像学检查在诊断进展中起着重要作用。作者建议在腹部钝性创伤特别是涉及车把、腹腔内游离液体和严重腹痛的情况下要谨慎。如果超声检查中胆囊壁显示中断或无法明确区分，我们建议高度怀疑胆囊穿孔。胆囊内回声性液体始终应怀疑腔内出血。由于体征和症状的发作可能会延迟，因此必须反复进行临床和影像学检查。
· 在上腹部腹部钝性创伤中意识到胆囊穿孔的可能性。· 涉及车把损伤的情况下，高度怀疑。· 强烈建议反复进行临床和影像学检查。
· Le MT, Herrmann J, Groth M 等人。儿童外伤性胆囊穿孔 - 病例报告和综述。Fortschr Röntgenstr 2021; 193: 889-897.
