2012 Volume 32 Issue 7 Pages 1251-1254
A 61-year-old-man who had drunk too much alcohol and fell down some stairs outdoors was transferred to a nearby hospital. Based on the CT findings, the patient was suspected as having intra-abdominal hemorrhage and was transferred to our emergency center. On examination, he was diagnosed as having gallbladder injury, and careful observation was decided on. Five days after the trauma, he exhibited peritoneal irritation. Abdominal enhanced computed tomography demonstrated suspected late rupture of the gallbladder, and an emergency laparotomy was performed. Bile-like peritoneal fluid was found in the abdomen. Cholecyhe stectomy and intraoperative cholangiography was performed, revealing no rupture of the gallbladder or damage to the bile duct. The cause of bile peritonitis was believed to be biliary oozing through avulsion of the cholecystic mucosa. The gallbladder is usually protected from trauma. In this case, due to the patient's state of inebriation, the tonicity of the abdominal wall was weak and he was unable to defend himself when he fell. Moreover, it was supposed that an increase of the internal pressure in the gallbladder and bile duct resulting in filling up of the gallbladder and contraction of the sphincter of Oddi brought about the resulting gallbladder injury.
