Traumatic Gallbladder Perforation in Children – Case Report and Review

Abstract

Background Gallbladder perforation is a very rare finding in children. Clinical and radiografic presentations are often vague. Hence it is a challenging diagnosis, often missed during initial evaluation with potentially fatal consequences. The aim of this case report and review was to identify factors that might help to diagnose and manage future cases.

Methods We present a case of gallbladder perforation in an 8-year-old child after blunt abdominal trauma caused by a handlebar in which imaging modalities such as ultrasound and magnetic resonance imaging (MRI) helped us to determine proper management. We identified and evaluated comparable cases for isolated traumatic gallbladder injury. A review of the recent literature was performed by online search in Pubmed and Google Scholar using “gallbladder injury in children”, “gallbladder perforation children”, “blunt abdominal trauma children” as keywords. We focused on articles exclusively in the pediatric section. The literature from the period 2000–2020 was taken into account to review the state of the art in diagnosis and management.

Results and Conclusion Recent literature for gallbladder injury in pediatrics is sparse compared to the adult counterpart. Only eight published cases of isolated gallbladder injury in children were identified. Since the onset of symptoms may not develop acutely and often develops in an indistinct manner, radiografic examinations play an important role in the diagnostic progress. The authors advise caution in cases of blunt abdominal trauma especially involving handlebars, intraperitoneal free fluid, and severe abdominal pain. We advocate high suspicion of gallbladder perforation if the gallbladder wall displays discontinuation or cannot be definitively differentiated in sonografic examination. Echogenic fluid within the gallbladder should always lead to suspicion of intraluminal bleeding. Repeated clinical and imaging examinations are mandatory since the onset of signs and symptoms may be delayed.

Key Points: 

• Awareness of gallbladder perforation in blunt abdominal trauma of the upper abdomen.

• Particularly high index of suspicion in cases involving handlebar injuries.

• Repeated clinical and imaging examinations are highly recommended.

Citation Format

• Le MT, Herrmann J, Groth M et al. Traumatic Gallbladder Perforation in Children – Case Report and Review. Fortschr Röntgenstr 2021; 193: 889 – 897

Zusammenfassung

Hintergrund Gallenblasenperforationen im Kindesalter sind sehr selten und einfach zu übersehen. Die klinischen und radiologischen Zeichen sind meist relativ unspezifisch. Entsprechend schwierig gestaltet sich die Diagnosestellung, sodass Gallenblasenverletzungen initial häufig übersehen werden mit potenziell fatalen Konsequenzen. Dieser Fallbericht mit Literaturübersicht sammelt die Kernessenzen hinsichtlich Diagnostik und Therapie dieses seltenen Krankheitsbildes.

Methode Wir stellen den Fall eines 8-jährigen Jungen nach stumpfem Bauchtrauma durch einen Fahrradlenker vor, in welchem bildgebende Verfahren, in unserem Falle Sonografie und Magnetresonanztomografie, ausschlaggebend für die richtige Therapie waren. Eine ergänzende Literaturrecherche vergleicht ähnliche Fallberichte mit isolierter Gallenblasenperforation bei Kindern. PubMed und Google Scholar wurden unter den Schlüsselbegriffen „gallbladder injury in children“, „gallbladder perforation children“, „blunt abdominal trauma children“ durchsucht. In die Recherche wurden ausschließlich pädiatrisch zentrierte Artikel mit Publikationsdatum zwischen 2000 und 2020 eingeschlossen, um möglichst einen zeitgemäßen Überblick zu gewährleisten.

Ergebnisse und Schlussfolgerung Gallenblasenperforationen bei pädiatrischen Patienten lassen sich in der aktuellen Literatur nur spärlich finden. Nur 8 vergleichbare Fälle konnten im oben genannten Zeitraum identifiziert werden. Da Symptome häufig verzögert und unspezifisch auftreten, spielen bildgebende Verfahren in der Diagnosefindung eine bedeutende Rolle. Besondere Achtsamkeit sollte bei stumpfen Bauchtraumen der oberen Bauchquadranten durch Fahrradlenker, freier Flüssigkeit und starken Abdominalschmerzen geboten sein. Ebenfalls alarmieren sollte eine sonografisch unvollständige Differenzierung oder Diskontinuität der Gallenblasenwand. Bei echoreicher Flüssigkeit im Gallenblasenlumen sollte stets eine intraluminale Blutung in Betracht gezogen werden. Da sich das Bild einer Gallenblasenverletzung oftmals verzögert manifestiert, sind zeitnahe klinische und radiologische Kontrolluntersuchungen unerlässlich.

Kernaussagen: 

• Beim stumpfen, oberen Bauchtrauma sollte eine Gallenblasenverletzung in Betracht gezogen werden.

• Bauchtraumen durch Fahrradlenkerverletzung bedürfen besonderer Achtsamkeit.

• Zeitnahe Wiederholung von klinischen und radiologischen Untersuchungen.

Key words

traumatic gallbladder injury in children - gallbladder perforation - handlebar injuries

Publication History

Received: 26 May 2020

Accepted: 02 December 2020

Article published online:
03 February 2021

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