A case report of biliary peritonitis from gallbladder injury: A rare complication of blunt abdominal trauma

Abstract

INTRODUCTION AND IMPORTANCE: Traumatic gallbladder injuries are rare, and isolated cases are exceptionally uncommon. Their diagnosis is often difficult due to non-specific clinical symptoms and imaging findings, frequently resulting in intraoperative discovery. PRESENTATION OF CASE: We present the case of a 99-year-old woman with no significant medical history who developed acute abdominal pain several hours after a fall. Physical examination revealed signs of peritonitis and hemodynamic instability. Laboratory tests showed systemic inflammation and evidence of organ dysfunction. Abdominal computed tomography revealed free intraperitoneal fluid but no definitive organ injury. Exploratory laparotomy uncovered a distended and perforated gallbladder with widespread bile leakage. A cholecystectomy was performed, and the patient recovered with minor complication. CLINICAL DISCUSSION: Gallbladder perforation following blunt trauma is a rare event, typically occurring alongside other intra-abdominal injuries. Risk factors include conditions that cause gallbladder distension, such as prolonged fasting. The absence of injuries to other organs in this case highlights the exceptional nature of isolated gallbladder trauma. Although laparoscopy is a valid surgical option, laparotomy remains necessary in hemodynamically unstable patients. CONCLUSION: This case underscores the diagnostic challenge and potential severity of gallbladder injury after blunt abdominal trauma. Early recognition and timely surgical management are crucial to avoid serious complications such as biliary peritonitis and multi-organ failure. A high degree of clinical suspicion is essential, especially in patients with known risk factors for gallbladder distension.