blunt trauma to the gallbladder is a rare entity , particularly when no other organ is injured . in isolated blunt traumatic injury to the gallbladder , treatment options vary depending on the specific injury . the types of blunt trauma injuries to the gallbladder and their appropriate management are discussed . a passenger admitted after a high - speed front - end motor vehicle crash was safely managed with laparoscopic surgery for a rare case of isolated gallbladder trauma . the preoperative and operative management are discussed as well as the application of minimally invasive surgery for this rare process . minimally invasive techniques may be safely applied to blunt trauma of the gallbladder in certain circumstances . perceived shortcomings of laparoscopy for the detection and management of traumatic injuries include inadequate visualization and altered tactile haptic feedback , which might increase the risk of missed injuries and affect patient morbidity and mortality . we report a case of traumatic gallbladder injury from blunt abdominal trauma that was diagnosed preoperatively and safely treated with laparoscopic cholecystectomy . a 35-year - old female was the restrained front - seat passenger in a high - speed motor vehicle collision . on arrival to the trauma center , she was awake and alert with a glasgow coma score of 15 and complaints of right upper quadrant ( ruq ) abdominal pain . a physical examination of her abdomen revealed a soft , nondistended abdomen with moderate ruq tenderness but no palpable mass or signs of peritoneal irritation . plain radiographs of the cervical spine , chest , and pelvis showed no evidence of acute injury . laboratory findings were within normal limits , with the exception of a hemoglobin of 10.0 mg / dl . computerized tomography of the abdomen showed a massively dilated gallbladder with pericholecystic fluid and heterogeneous intraluminal fluid consistent with blood and thrombus ( figure 1 ) . while under observation , the patient developed increasing ruq pain and localized peritonitis . laparoscopy revealed a massively dilated gallbladder without evidence of hepatic , duodenal , or pancreatic injury ( figure 2 ) . gross inspection of the specimen showed a markedly enlarged gallbladder filled with thrombus without evidence of cholelithiasis ( figure 3 ) . although the gallbladder is the most commonly injured segment of the extrahepatic biliary tree , trauma to this organ is a rare entity , comprising only 0.5% to 0.6% of all traumatic intraabdominal injuries . factors believed to predispose the gallbladder to blunt injury include a thin gallbladder wall , postprandial distention , and alcohol ingestion . in blunt trauma , associated intraabdominal injuries particularly to the liver , spleen , and duodenum are common . an average of greater than 3 intraabdominal injuries per patient was reported in 1 series . several classification systems have been reported in the literature to describe the spectrum of injury that may occur to the gallbladder . none has gained widespread use or acceptance perhaps because of the rare nature of the injury and the lack of a clear continuum of injury as seen in the grading systems of solid organs . rather than conceptualize a spectrum of injury to the gallbladder , it may be more appropriate to define 4 separate patterns of injury : contusion , perforation , avulsion , and traumatic hemorrhagic cholecystitis . gallbladder contusion represents isolated injury to the gallbladder wall and may be associated with intramural hemorrhage . the progression of an area of contusion to ischemia and necrosis with perforation has been reported , but probably represents a very rare event . free perforation of the gallbladder with extravasation of bile into the peritoneal cavity is seen most commonly . gallbladder avulsion may be partial , with some degree of attachment to the gallbladder fossa , or complete , with complete separation of the gallbladder from the liver bed . complete separation of the gallbladder from the liver with division of the cystic duct and artery has been described as traumatic hemorrhagic cholecystitis , as we have described in this report , has been described previously , and represents either direct hemorrhage into the gallbladder from injury to the wall or mucosa or hemorrhage into the biliary tree with reflux of blood into the gallbladder . most often , cholecystectomy is undertaken at the time of open laparotomy for other associated injuries . intraoperative evaluation of the biliary tree is imperative to rule out concomitant bile duct injury . we have demonstrated that laparoscopic surgical techniques may be safely used in instances where the likelihood of associated injuries is low , and definitive treatment can be rendered without increasing patient morbidity and mortality .
background and objectives : blunt trauma to the gallbladder is a rare entity , particularly when no other organ is injured . in isolated blunt traumatic injury to the gallbladder , treatment options vary depending on the specific injury . the types of blunt trauma injuries to the gallbladder and their appropriate management are discussed . 
 in addition , a case successfully managed with minimally invasive techniques is presented.methods:a passenger admitted after a high - speed front - end motor vehicle crash was safely managed with laparoscopic surgery for a rare case of isolated gallbladder trauma . 
 the preoperative and operative management are discussed as well as the application of minimally invasive surgery for this rare process.results:laparoscopic cholecystectomy was performed successfully . 
 the patient did well postoperatively with no complications . 
 no other injuries were identified at the time of laparoscopy.conclusion:minimally invasive techniques may be safely applied to blunt trauma of the gallbladder in certain circumstances .