Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy): a case report and review of the literature

A case of isolated complete avulsion of the gallbladder (near traumatic cholecystectomy) from its hepatic bed in a 46-year-old Caucasian man without any other sign of injury is presented. The avulsion was due to blunt abdominal trauma after a car accident. The rarity of this injury and the stable condition of our patient at the initial presentation warrant a description. The diagnosis was made incidentally after a computed tomography scan, and our patient was treated successfully with ligation of the cystic duct and artery, removal of the gallbladder, coagulation of the bleeding points, and placement of a drain.Early diagnosis of such injuries is quite difficult because abdominal signs are poor, non-specific, or even absent. Therefore, a computed tomography scan should be performed when the mechanism of injury is indicated.The first specimen of a lacerated gallbladder from a blunt trauma was found in Guy's Museum in London and dates from 1388 [1]. The first known case of someone surviving a gallbladder traumatic rupture was in 1898 [1]. Penn [2] reported the incidence of gallbladder trauma to be 1.9% in a collected review of 5670 cases of blunt and penetrating trauma. Complete detachment of the gallbladder from its hepatic bed, one of the rarest consequences of blunt abdominal trauma, is rarer than gallbladder contusion, perforation, and partial contusion. The few reports in the literature are not clearly enumerated [3-9], because of a lack of appropriate description before the advanced classification of Losanoff and Kjossev [4].The gallbladder is a well-protected organ, being partially embedded in the relatively massive liver substance, cushioned on the surrounding omentum and intestines, and covered by the bony cartilaginous rib cage. As a result, gallbladder trauma due to a blunt injury is rare and usually is associated with additional external or visceral injuries [2,5,6,8]. Isolated complete avulsion of the gallbladder after non-penetrating abdominal trauma in