Abstract
A 36-year-old man was admitted to our hospital because of an alcohol-related traffic accident. He was hemodynamically stable but had tenderness in the right upper abdomen. Dynamic CT showed an expanded gallbladder and showed contrast material leaking from the gallbladder wall. The patient had rib fractures but no ascites, free air, or solid organ injury. We diagnosed the patient's condition as intragallbladder bleeding and initially selected conservative therapy because his vital signs were stable. Since the paitent's epigastric pain did not show signs of improvement, we performed open cholecystectomy on the eighth hospital day. We found that the gallbladder was expanded and filled with clots ; the markedly thickened wall bled easily. To date, 23 cases of intragallbladder bleeding due to blunt injury have been reported in Japan, and cholecystectomy was performed in 16 of these cases. In a recent report, 5 patients improved following treatment with conservative therapy only.
However, 3 patients developed acute cholecystitis following conservative therapy and subsequently required an emergency operation.
Some case reports have described cholecystectomy being carried out because of acute cholecystitis after improvement in abdominal pain. Therefore, an operation is recommended for patients with intragallbladder bleeding.
