Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8518
Peer-review started: April 6, 2021
First decision: April 28, 2021
Revised: May 12, 2021
Accepted: August 5, 2021
Article in press: August 5, 2021
Published online: October 6, 2021
We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury. We report that the patient was safely treated by conservative treatment after the obstruction was resolved by endoscopic retrograde cholangiopancreatography (ERCP).
A 67-year-old man was admitted via the emergency department due to complaints of right-sided abdominal pain that started 2 d prior. Four days prior to presentation, the patient had slipped, fallen and struck his abdomen on a motorcycle handle. His initial vital signs were stable. On physical examination, he showed right upper quadrant pain and Murphy’s sign, with decreased bowel sounds. Additionally, he had had a poor appetite for 4 d. He had been on aspirin for 2 years due to underlying hypertension. Initial simple radiography revealed a slight ileus. The laboratory findings were as follows: white blood cell count, 15.5 × 103/µL (normal range 4.8 × 103–10.8 × 103); hemoglobin, 9.4 g/dL; aspartate aminotransferase/alanine transferase, 423/348 U/L; total bilirubin/direct bilirubin, 4.45/3.26 mg/dL; -GTP , 639 U/L (normal range 5–61 U/L); and C-reactive protein, 12.32 mg/dL (0–0.3). Abdominal computed tomography showed a distended gallbladder with edematous wall change and a 55 mm × 40 mm hematoma. Dilatation was observed in both the intrahepatic and common bile duct areas. Antibiotic treatment was initiated, and ERCP was performed, with hemobilia found during treatment. After cannulation, the patient’s symptoms were relieved, and after conservative management, the patient was discharged with no further complications. After 1-month follow-up, the gallbladder hematoma was completely resolved.
In the case of traumatic injury to the gallbladder, conservative treatment is feasible even in the presence of hematoma.
Core tip: Intragallbladder hematoma is a rare event in trauma. Most of the hematomas in the gallbladder and blunt traumatic injury of the gallbladder itself can lead to complications such as delayed perforation, gallstone formation due to clot retention, and hemorrhagic cholecystitis. In most cases, these gallbladder hematomas require cholecystectomy or external drainage. However, such as in our case, after endoscopic retrograde cholangiopancreatography was performed and retention of the tract was resolved, conservative treatment should be considered as a treatment option if the laboratory test results show improvement, and the patient shows a favorable clinical course.