CASE REPORT Isolated traumatic gallbladder rupture: US findings and the role of repeat US in diagnosis Hatice Ozturkmen Akay & Senem Senturk & M. Kemal Cigdem & Aylin H. Bayrak & Erdal Ozdemir Received: 6 November 2007 / Accepted: 19 December 2007 / Published online: 2 February 2008 # Springer-Verlag 2008 Abstract We represent the US findings of isolated gall- bladder rupture caused by blunt abdominal trauma in a 13- year-old boy. At the initial US examination, although a pericholecystic fluid collection was observed, the mildly collapsed gallbladder was regarded as a contracted gall- bladder. Even though the patient was haemodynamically stable, repeat US examination after 24 h revealed gallblad- der perforation. In haemodynamically stable trauma patients repeated US examinations can be useful and are strongly recommended. Keywords Gallbladder . Trauma . Rupture . Ultrasound . Child Introduction Traumatic injury to the gallbladder, observed in 2–3% of patients with blunt abdominal trauma, is uncommon and frequently associated with other intraabdominal injuries [1– 3]. The diagnosis is usually established during laparotomy performed for other associated injuries. In this report we present the US findings of isolated gallbladder rupture, an uncommon complication of blunt abdominal trauma. Case report A 13-year-old boy, hit in the right upper quadrant during a fight, was admitted to the emergency room. He presented with severe abdominal pain and nausea, and examination disclosed moderate epigastric tenderness. General physical examination revealed tachycardia (130/min), mild hypoten- sion (90/60 mmHg) and pyrexia (38.5°C). Laboratory values included haemoglobin 9.4 g/dl, haematocrit 27.2%, WBC count 16.8×10 3 /μl, SGOT 47 U/l, SGPT 21 U/l, lactate dehydrogenase 35.4 U/l, total bilirubin 4 mg/dl, direct bilirubin 2.7 mg/dl, and indirect bilirubin 1.3 mg/dl. The first abdominal US examination performed by a radiology resident in the emergency room revealed a small perihepatic and pericholecystic fluid collection with mild gallbladder collapse, considered as gallbladder contraction. No solid-organ injury was determined. Since the patient was hemodynamically stable, he was observed without any intervention. Although there was no significant change in laboratory values, abdominal tenderness and right upper quadrant pain gradually increased. The US examination was repeated after 24 h utilizing a 3.5-MHz probe. Despite 34 h of fasting, the gallbladder was still collapsed with prominent wall thickening. In addition, a full-thickness tear of the medial wall at the fundus was demonstrated (Fig. 1). Free fluid was observed in the peritoneal cavity, most of which was around the gallbladder (Fig. 1). No additional intraabdominal pathology was detected. At emergent laparotomy there was widespread haemor- rhagic fluid in the peritoneal cavity. A haematoma mixed with bile was identified around the gallbladder. After locating the 2-cm-diameter perforation at the fundus, cholecystectomy was performed. No additional biliary or intraabdominal injury was observed at laparotomy. He had Pediatr Radiol (2008) 38:691–693 DOI 10.1007/s00247-008-0759-3 H. O. Akay (*) : S. Senturk : A. H. Bayrak : E. Ozdemir Department of Radiology, Dicle University Medical School, Diyarbakir 21280, Turkey e-mail: hozturkmen@gmail.com M. K. Cigdem Department of Paediatric Surgery, Dicle University Medical School, Diyarbakir, Turkey