Post-Traumatic Gallbladder Injury in Children: Case Report
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Lesions of the gallbladder are rare. They are the results of direct hits, shear acceleration/deceleration or more commonly penetrating wounds. The lesion’s types are classified as contusion, perforation and avulsions. Diagnosis of vesicular perforation is a challenge for the clinician.

14-year-old boy: a victim of abdominal trauma following a stabbing attack was hospitalized initially at a peripheral hospital where he received primary care. Clinically, the examination was marked by a right base-thoracic wound of 3 cm, a distended sensitive abdomen (epigastrium the right hypochondrium and the flanks). An abdominal US found a hepatic contusion (left lobe) associated with haemoperitoneum, the gallbladder was normal but it contained echogenic sediment, probably hemobilia. The angio scan showed an abundant haemoperitoneum with a peri vesicular hematoma, and hepatic contusion (segment IV). He benefited from a biological assessment, prophylaxis antibiotic, blood transfusion; clinical biology and radiology monitoring. He was discharged on the 5th day after clinical stabilization. It is readmitted at D + 8 of the trauma for haematic fluid with lumps of pus through the para-gastric wound. Biological assessment was performed. Abdominal ultrasound: liver was normal, respect of portal and biliary structures, intraperitoneal effusion with finely echogenic content.

Peritoneal fluid sampling study showed: hematic color with 300,000 red blood cells and 20,000 white blood cells including 77% PNN, with E. coli to culture. Antibiotic has been adapted to the anti-biogramme. He benefited from a cystoscopy which revealed a significant inflammation of the digestive tract with the presence of numerous false membranes on the underside limiting the exploration, locating the point of introduction of the knife which sits at the level of the upper face liver.

At D + 12, cholecystectomy was performed by laparotomy. A compartmentalized pelvic effusion (biliary peritonitis), a significant inflammation of the digestive tract with several adhesions, and a hepatic transvesiculo-cutaneous fistula was found. The postoperative evolution was simple, removal of the slides at D + 4 and discharged at D + 7 postoperative after improvement. At the 6th month, he presented an acute intestinal obstruction on bridles, managed at emergency by open surgery. Release of the flanges is between the 6th and 9th intestinal loop. After one year of follow up, the patient has no symptoms.