Santos Matheus de Oliveira, Coimbra Larissa S, Sardow Aline, Pelosi Rafael B, Scarpelini Sandro
Division of Trauma and Acute Care Surgery, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (FMRP-USP), Ribeirão Preto, BRA.
Cureus. 2025 Jun 9;17(6):e85588. doi: 10.7759/cureus.85588. eCollection 2025 Jun.
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.
钝性腹部创伤继发的胆囊损伤是一种罕见情况，在初始评估时可能被漏诊。我们报告一例65岁男性患者，有长期酗酒和吸烟史，在遭受人身攻击两周后入院，伴有面部创伤、腹痛，血流动力学稳定。初始影像学检查显示III级肝损伤和胆囊壁轻度增厚。患者最初接受保守治疗。然而，在48小时内，他出现持续的右上腹疼痛、低热、白细胞增多和墨菲氏征阳性。腹部超声显示胆囊壁增厚和腔内高回声内容物，提示有血凝块。腹腔镜胆囊切除术证实为胆囊挫伤伴壁内血肿和腔内血凝块，而肝损伤无活动性出血。患者恢复顺利，次日出院。该病例强调了对钝性腹部创伤患者保持临床警惕的重要性，特别是当尽管影像学检查结果稳定但症状持续存在时。胆囊挫伤在影像学上可能不易检测到，高度怀疑对于及时诊断和治疗至关重要。手术干预仍然是确定性治疗方法，可以预防胆汁性腹膜炎或败血症等并发症。本报告增加了关于隐匿性胆囊损伤的有限文献，并强调了在类似病例中密切随访和早期手术干预的重要性。
