Post-traumatic ischemia of the gallbladder: a case report

Post-traumatic ischemic injuries of the gallbladder are exceptional, and the incidence of isolated gallbladder injuries is even rarer. We present a case of gallbladder ischemia following abdominal contusion, leading to thrombosis of the cystic artery and complicated by rupture. A 35-year-old man presented to the emergency department three days after a blunt abdominal trauma. He complained of persistent epigastric pain radiating to the back and the right upper quadrant. On arrival, the patient had a slightly elevated temperature, normal blood pressure, and moderate tachycardia. Abdominal examination revealed marked tenderness in the right upper quadrant with signs of localized peritonitis. Laboratory tests showed a C-reactive protein level of 300 mg/L and leukocytosis with predominant neutrophils (15,000/mm³). Abdominal computed tomography (CT) revealed moderate ascites in the peri-hepatic space, a thickened gallbladder wall, and a discontinuity of the gallbladder wall at the fundus. The patient underwent an emergency laparotomy through a right subcostal incision. Surgical exploration revealed a completely ischemic gallbladder with a rupture at the fundus and localized bile leakage in the subhepatic space. Complete thrombosis of the cystic artery was identified, with no associated injury to the hepatic parenchyma or vascular structures. A cholecystectomy was performed due to the friable nature of the gallbladder. No bile leak was detected, and the postoperative course was uncomplicated.