Importance of Investigating Occult Gallbladder Injury in Hepatic Trauma: A Case Report.

Gallbladder injury secondary to blunt abdominal trauma is a rare condition and may be missed during the initial evaluation. We present the case of a 65-year-old male patient with a history of chronic alcohol and tobacco use who was admitted two weeks after a physical assault, with facial trauma, abdominal pain, and hemodynamic stability. Initial imaging revealed a grade III hepatic injury and mild thickening of the gallbladder wall. The patient was initially managed conservatively. However, within 48 hours, he developed persistent right upper quadrant pain, low-grade fever, leukocytosis, and a positive Murphy's sign. Abdominal ultrasound showed thickening of the gallbladder wall and intraluminal hyperechoic content, suggestive of clots. Laparoscopic cholecystectomy confirmed gallbladder contusion with an intramural hematoma and intraluminal clots, while the liver injury showed no active bleeding. The patient recovered uneventfully and was discharged the following day. This case highlights the importance of maintaining clinical vigilance in patients with blunt abdominal trauma, particularly when symptoms persist despite stable imaging findings. Gallbladder contusions may not be easily detected on imaging, and a high index of suspicion is crucial for timely diagnosis and treatment. Surgical intervention remains the definitive treatment and can prevent complications such as bile peritonitis or sepsis. This report adds to the limited literature on occult gallbladder injuries and emphasizes the importance of close follow-up and early surgical intervention in similar cases.