A decade of experience with injuries to the gallbladder

Injuries to the gallbladder occurred in 45 patients, 40 (89%) of whom suffered penetrating trauma. Associated injuries were present in 44 (98%) patients, including 10 (22%) pancreatic injuries requiring repair and/or drainage. Patients were severely injured (49% hemodynamically unstable at presentation; mean Injury Severity Score = 20; mean length of stay = 22 days; mortality rate = 24%). Cholecystectomy was performed in 42 patients (93%), while the remaining 3 had drainage only as part of a "damage control" operation related to their critical physiologic status. Injuries to the extrahepatic biliary ducts occurred in 3 patients (7%) as well. Although all patients developed trauma related complications, none were a direct result of their biliary tract injuries.Injuries to the gallbladder are rare even in the busiest urban trauma centers. Almost all patients have associated intra-abdominal injuries, and nearly 50% of patients are hemodynamically unstable on admission. Rapid cholecystectomy is the treatment of choice for all mechanisms of injury, except when the first operative procedure is of the damage control type.Trauma to the gallbladder is rare even in the busiest centers. This likely relates to its inherent surrounding protection afforded by the liver, intestines, omentum and thoracic cage. As a result, injuries tend to be a result of direct blows, acceleration/deceleration shearing, or more commonly penetrating mechanisms [1,2]. Gallbladder trauma also tends to occur in association with multiple concurrent intra-abdominal injuries [1,2].Although the gallbladder plays a central role in the storage, concentration and regulation of bile, it is also an organ that can be removed [3]. Furthermore, because concurrent gallbladder diseases such as cholecystitis or choleduodenal fistulas are extremely rare in the injured patient, cholecystectomies can be completed rapidly. This procedure is extremely safe, with an associated bile duct injury rate of less than 1% [2] and