Isolated gallbladder perforation following blunt abdominal trauma in a six-year-old child

Isolated perforation of the gallbladder secondary to blunt trauma is rare. Furthermore, only a few cases exist in the infant age group. It has vague symptoms and interpretation of the radiology imaging is challenging. Diagnosis is usually made at operation. We report the case of a six-year-old boy who fell on to the handlebars of his scooter, sustaining an isolated gallbladder perforation. The authors highlight the importance of interpreting the volume of intraperitoneal fluid and early diagnostic laparoscopy.

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Isolated gallbladder perforation in paediatric blunt abdominal injury: A case report and review of literature

IP International Journal of Medical Paediatrics and Oncology ◽

10.18231/j.ijmpo.2021.020 ◽

2021 ◽

Vol 7 (2) ◽

pp. 103-107

Author(s):

Sujoy Neogi ◽

Arka Banerjee ◽

Shasanka S Panda ◽

Simmi K Ratan

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Diagnostic Laparoscopy ◽

Road Accident ◽

Organ Injury ◽

Current Evidence ◽

Gallbladder Perforation ◽

Free Fluid ◽

Solid Organ ◽

Blunt Abdominal Injury

Gallbladder injury in blunt abdominal trauma is rare, around 2% of all abdominal traumas. Vague symptoms and inconclusive imaging make it an elusive diagnosis, more so in children. Only 30 pediatric cases have been reported worldwide till date. We report a case of a 7yrs old boy presenting 2 weeks after a road accident with a gallbladder rupture which was eventually discovered on a diagnostic laparoscopy. This is the second such case being reported from India. The injury is most often identified at exploration and although cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ. The classification system of Losanoff and Kjossev has merit in guiding treatment. The various presentations, mechanisms and modes of injury have been highlighted along with the clinical and imaging findings. Despite the developments in modern radiology, identifying gallbladder perforation has always been difficult because of the rarity of the condition. In a child with blunt abdominal trauma and intra-abdominal free fluid without any solid organ injury, a diagnostic peritoneal tap may be helpful. Based on the current evidence, we advocate a low threshold for performing a diagnostic laparoscopy in all such cases.

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Isolated Gallbladder Perforation in Cases of Blunt Trauma Abdomen

Nepalese Journal of Radiology ◽

10.3126/njr.v3i2.9614 ◽

2014 ◽

Vol 3 (2) ◽

pp. 72-76

Author(s):

MK Gupta ◽

K Ahmad ◽

A Kumar ◽

PK Santhalia ◽

BR Joshi ◽

...

Keyword(s):

Computed Tomography ◽

Early Diagnosis ◽

Blunt Trauma ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Open Cholecystectomy ◽

Diagnosis And Treatment ◽

Gallbladder Perforation ◽

Diagnostic Challenge ◽

Multi Detector Computed Tomography

Isolated perforation of gallbladder (GB) following blunt trauma abdomen is extremely rare and may pose a diagnostic challenge. Early diagnosis and treatment is of paramount importance to reduce morbidity and mortality associated with GB perforation. We present two cases of isolated GB perforation in patients of blunt abdominal trauma diagnosed on multi-detector computed tomography (MDCT) which was corroborated by bile stained peritoneal aspirate and subsequently confirmed by surgery. Both the patients underwent open cholecystectomy with good outcome.DOI: http://dx.doi.org/10.3126/njr.v3i2.9614 Nepalese Journal of Radiology Vol.3(2)July-Dec, 2013: 72-76

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Traumatic Gallbladder Perforation in Children – Case Report and Review

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/a-1339-1904 ◽

2021 ◽

Author(s):

Melanie Thanh Phuong Le ◽

Jochen Herrmann ◽

Michael Groth ◽

Konrad Reinshagen ◽

Michael Boettcher

Keyword(s):

Case Report ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Recent Literature ◽

Signs And Symptoms ◽

Gallbladder Wall ◽

Gallbladder Perforation ◽

Free Fluid ◽

Key Points ◽

Magnetic Resonance Imaging Mri

Background 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. Methods 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. Results and Conclusion 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. Key Points: Citation Format

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Prospective study of management and outcome of blunt abdominal trauma (solid organs and hollow viscus injuries)

International Surgery Journal ◽

10.18203/2349-2902.isj20174143 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3262 ◽

Cited By ~ 1

Author(s):

Sandesh Kumar Srivastava ◽

Anand Kumar Jaiswal ◽

Dinesh Kumar

Keyword(s):

Prospective Study ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Road Traffic ◽

Age Groups ◽

Initial Assessment ◽

Age Group ◽

Abdominal Injuries ◽

Hollow Viscus ◽

External Compression

Background: Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. Many injuries may not manifest during the initial assessment and treatment period. Injury to intra-abdominal structures can be classified into 2 primary mechanism of injury-compression forces and deceleration forces. Compression or concussive force may result from direct blows or external compression against a fixed object. Deceleration forces causes stretching and linear shearing between relatively fixed and free objects.Methods: A prospective study of 48 patients admitted with blunt abdominal injuries in the department of surgery, B.R.D. Medical College Gorakhpur during a period of 1 year.Results: Majority of patients of blunt abdominal injuries in present study were in 11-20 year of age group followed by 31-40 year of age group followed by 41-50 year of age group. Female to male ratio was 7:1. In the present study 41% of patients were subjected to non-operative management.Conclusions: Males were pre-dominantly affected. Road traffic accident was the most common cause of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment.

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Isolated gallbladder perforation after blunt abdominal trauma in children

African Journal of Paediatric Surgery ◽

10.4103/0189-6725.109395 ◽

2013 ◽

Vol 10 (1) ◽

pp. 41 ◽

Cited By ~ 4

Author(s):

Oumar Ndour ◽

Helle Moustapha ◽

NdeyeAby Ndoye ◽

Gabriel NGom

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Gallbladder Perforation

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Severe Spasm of the Renal Artery after Blunt Abdominal Trauma Simulating End-Organ Infarction

Case Reports in Medicine ◽

10.1155/2010/207152 ◽

2010 ◽

Vol 2010 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Adem Ucar ◽

Aghakishi Yahyayev ◽

Ayaz Agayev ◽

Fatih Yanar ◽

Selim Bakan ◽

...

Keyword(s):

Renal Artery ◽

Blunt Trauma ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Arterial Occlusion ◽

Endovascular Intervention ◽

Surgical Revascularization ◽

Injury Management ◽

Main Renal Artery ◽

Serious Injury

Traumatic occlusion of the renal artery is a serious injury. Management differs according to the grade of injury. In most circumstances, emergency surgical revascularization or endovascular intervention is required. We describe the case of a child with multiorgan injuries and spasm of the main renal artery after blunt trauma simulating arterial occlusion or end-organ infarction.

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The spectrum and outcome of blunt trauma related enteric hollow visceral injury

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0013 ◽

2018 ◽

Vol 100 (4) ◽

pp. 290-294 ◽

Cited By ~ 4

Author(s):

W Bekker ◽

VY Kong ◽

GL Laing ◽

JL Bruce ◽

V Manchev ◽

...

Keyword(s):

Blunt Trauma ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Delayed Diagnosis ◽

Free Fluid ◽

Visceral Injury ◽

X Ray ◽

Median Delay ◽

Chest X Ray ◽

Hollow Visceral Injury

Introduction This audit focused on patients who sustained enteric injury following blunt abdominal trauma. Methods Our prospectively maintained electronic registry was interrogated retrospectively, and all patients who had sustained blunt abdominal trauma between December 2011 and January 2016 were identified. Results Overall, 2,045 patients had sustained blunt abdominal trauma during the period under review. Seventy per cent were male. The median age was 28 years. Sixty patients (2.9%) sustained a small bowel injury (SBI). Thirty-five of these were peritonitic on presentation. All patients with a SBI had a chest x-ray and free air was present in seven. In 18 patients with a SBI, computed tomography (CT) was performed, which revealed isolated free fluid in 12 and free intraperitoneal air in 5. In five cases, the CT was normal. A total of 32 patients (1.5%) sustained blunt duodenal trauma (BDT). All patients with BDT had a chest x-ray on presentation. Free intraperitoneal air was not present in any. CT was performed on 17 patients with BDT. This revealed isolated free fluid or retroperitoneal air in 12. The median delay between injury and presentation for these enteric injures was 15.5 hours (interquartile range [IQR]: 8–25 hours) while between presentation at hospital and operation, the median delay was 6 hours (IQR: 3–13 hours). Conclusions Blunt trauma related enteric hollow visceral injury remains associated with delayed diagnosis and significant morbidity. It can be caused by a disparate array of mechanisms and is difficult to diagnose even with modern imaging strategies.

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Epidemiology and injury pattern in blunt trauma abdomen in pediatric population: a two-year experience in a tertiary care institute of Kashmir, India

International Surgery Journal ◽

10.18203/2349-2902.isj20184650 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3713

Author(s):

Arshid Iqbal Qadri ◽

Younis Ahmad ◽

Gowhar Aziz Bhat ◽

Aamir A. Khan ◽

Khalid Bashir

Keyword(s):

Blunt Trauma ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Predictive Value ◽

Road Traffic ◽

Pediatric Population ◽

Tertiary Care ◽

Pediatric Trauma ◽

Injury Pattern ◽

Trauma Patients

Background: Blunt abdominal trauma is a frequent cause for presentation of children to the Emergency Department. Children are prone to sustain injuries to intra-abdominal organs after blunt abdominal trauma because of their peculiar body habitus and relatively immature musculoskeletal system. Objectives of this study is to assess the various epidemiological parameters that influences the causation of trauma as well as injury pattern in blunt trauma abdomen in pediatric population.Methods: The present observational hospital based prospective study was carried out in 96 blunt abdominal trauma patients of both sexes aged up to 12 years, over a period of 2 years. The parameters such as age group, sex, mode of trauma, type of injury, and the overall mortality as well as mortality were assessed.Results: The most common mode of injury was road traffic accidents (54.2%) followed by fall from height (41.70%). Splenic injury was the most common in 58.30%, followed by hepatic injuries 34.40% and renal injuries 12.50 %. The accuracy of ultrasonography (USG) was 83.33% while accuracy of computed tomography (CECT) as a diagnostic test was 93.33%. When comparing USG findings with operative findings sensitivity of USG was 88% with positive predictive value (PPV) of 91.66% while as specificity was 60% with negative predictive value (NPV) of 50%. Sensitivity of CT scan was 96.00% with PPV of 96.00% and specificity of CECT scan was 80.00% with NPV of 80.00%.Conclusions: The majority of pediatric injuries are preventable by knowing the epidemiology and pattern of pediatric trauma.

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