Spontaneous resolution of gallbladder hematoma in blunt traumatic injury: A case report

Abstract

BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury. We report that the patient was safely treated by conservative treatment after the obstruction was resolved by endoscopic retrograde cholangiopancreatography (ERCP). CASE SUMMARY A 67-year-old man was admitted via the emergency department due to complaints of right-sided abdominal pain that started 2 d prior. Four days prior to presentation, the patient had slipped, fallen and struck his abdomen on a motorcycle handle. His initial vital signs were stable. On physical examination, he showed right upper quadrant pain and Murphy’s sign, with decreased bowel sounds. Additionally, he had had a poor appetite for 4 d. He had been on aspirin for 2 years due to underlying hypertension. Initial simple radiography revealed a slight ileus. The laboratory findings were as follows: white blood cell count, 15.5 × 10 3 /µL (normal range 4.8 × 10 3 –10.8 × 10 3 ); hemoglobin, 9.4 g/dL; aspartate aminotransferase/alanine transferase, 423/348 U/L; total bilirubin/direct bilirubin, 4.45/3.26 mg/dL; -GTP , 639 U/L (normal range 5–61 U/L); and C-reactive protein, 12.32 mg/dL (0–0.3). Abdominal computed tomography showed a distended gallbladder with edematous wall change and a 55 mm × 40 mm hematoma. Dilatation was observed in both the intrahepatic and common bile duct areas. Antibiotic treatment was initiated, and ERCP was performed, with hemobilia found during treatment. After cannulation, the patient’s symptoms were relieved, and after conservative management, the patient was discharged with no further complications. After 1-month follow-up, the gallbladder hematoma was completely resolved. CONCLUSION In the case of traumatic injury to the gallbladder, conservative treatment is feasible even in the presence of hematoma.