Unlikely Double Trouble: Two Cases of Haemobilia From One Motor Vehicle Accident

Blunt abdominal trauma frequently results in visceral injury to either solid or hollow organs; however, injury to the gallbladder is rare. This is most likely due to the anatomical position of the gallbladder, which is well-insulated posterior to the liver and rib cage. Gallbladder injuries can be in the form of avulsion, contusion, or laceration. In the same clinical spectrum as contusion is haemobilia, which is defined as bleeding into the biliary system and may result from injury to any of the structures associated with the biliary tree (liver, gallbladder, bile ducts or pancreas). Risk factors for traumatic injury to the gallbladder include distension of the gallbladder due to recent alcohol ingestion or fasting and deceleration-type mechanisms, which may cause compression of the gallbladder against the spine. Haemobilia is an important diagnosis with important clinical implications. If undiagnosed, traumatic haemobilia can result in complications such as delayed gallbladder perforation secondary to local ischemia or cholecystitis secondary to obstructing blood clots, which can add to the associated injury burden in trauma patients. Although extremely rare, we present an unlikely scenario of two patients who were involved in the same motor vehicle crash, and both were found to have traumatic haemobilia that required surgical management with cholecystectomy. A high degree of suspicion is required to avoid missed/delayed diagnosis of haemobilia, which may have serious complications that can lead to increased morbidity and mortality in trauma patients.