Handlebar versus gallbladder: A case of gallbladder rupture in blunt thoracoabdominal trauma without other major injury

Abstract

A 51-year-old male presented to the emergency department 4 h after falling off a pushbike onto his right side at 20 km/h. He presented to hospital after initially returning home for a brief period, where he reported symptoms of dizziness and nausea and noticed increased swelling to of right side of his abdomen. Primary assessment was significant for blood pressure of 75/48mmHg (heart rate 86 bpm), which improved to 105/67 with 1 L intravenous 0.9% saline. Focused abdominal ultrasound showed free fluid in right upper quadrant. Secondary survey identified right chest wall tenderness, right upper quadrant tenderness and distension, and grazes on the abdomen. He proceeded to contrast enhanced computer tomography (CT) that demonstrated haemoperitoneum, grade II splenic laceration [2], right sixth to eighth rib fractures, and right transverse process fracture of the first lumbar vertebra (Fig. 1). The patient underwent an emergency trauma laparotomy, that revealed one litre haemoperitoneum, perforated gallbladder with free gallbladder calculi, grade I duodenal haematoma and a grade II splenic laceration. The bleeding was from the gallbladder mucosa and peritoneal covering; the duodenal and splenic injuries were not bleeding. His gallbladder was resected (Fig. 2), and calculi retrieved. His gallbladder appeared fibrosed, as confirmed on histopathology that showed fibrosis. The duodenum and spleen were managed conservatively. He had an uncomplicated recovery post-operatively, with conservative management of the rib and vertebral fractures, and was discharged home seven days later.