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Gallbladder perforation in blunt traumatic injury

Published:April 17, 2022DOI:https://doi.org/10.1016/j.surg.2022.03.016
      A 49-year-old man with a history of HIV presented to an urban level 1 trauma center as a pedestrian struck by a motor vehicle. In the trauma bay, the patient was hemodynamically stable (blood pressure 118/82 mm Hg) with sinus tachycardia (heart rate 107 beats/min). He was breathing comfortably with an SpO2 of 100% on room air, and he was alert and oriented with a Glasgow Coma Score of 15. The patient was in moderate distress, and complained of severe abdominal pain exacerbated by movement and transfer. He exhibited rebound tenderness on abdominal exam. His secondary survey was otherwise negative. Labs demonstrated a leukocytosis of 17.6, and a high anion gap acidosis (CO2 19, anion gap 16). Focused Assessment with Sonography in Trauma (FAST) exam was negative for free fluid. Computed tomography (CT) of the abdomen and pelvis shows Couinaud segment V liver laceration, laceration on the gallbladder, and perihepatic free fluid (Figure 1). What is the diagnosis?
      Figure thumbnail gr1
      Figure 1(A) Axial and (B) coronal contrast-enhanced abdominal and pelvic CT performed during initial trauma evaluation shows laceration of the liver in Couinaud segment V (black arrow) and rupture of the gallbladder fundus (white arrow). Note the perihepatic free fluid (white asterisk).
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