The authors highlight the incidence of associated visceral injuries in gallbladder trauma (>90%). Gallbladder perforation is more likely in cases when the gallbladder is distended and thin-walled at the time of injury. Therefore, we recommend that gallbladder perforation is suspected in those patients who have drunk alcohol or eaten recently. Despite the developments in modern computed tomography, identifying gallbladder perforation is difficult because of the subtlety and rarity of the condition. We draw attention to the proposed anatomic classification systems because they are of some use in guiding treatment. In the absence of a diagnosis after blunt abdominal trauma and with intra-abdominal free fluid, the clinician faces the difficult decision of whether surgery is indicated for a potential visceral injury. After discussing the available evidence, the authors advocate a low index of suspicion for performing diagnostic laparoscopy.

4 (based on lowest level of article analyzed in meta-analysis/systematic review).

No abstract

Renal outcome is good in isolated hyperechogenic kidneys, with 79% having normal renal function. Importantly, for prognostic counselling, all of the children in our non-selected series with isolated echogenic kidneys and normal amniotic fluid levels had normal renal outcome in infancy. What are the clinical implications of this work? Prenatal diagnosis of hyperechogenic kidneys allow early recognition and treatment of a renal disease in addition to counseling the family about the postnatal outcome and allow them to make decisions regarding pregnancy care and delivery.