A 56 year old man presents 20 minutes after being struck by a motorcycle, while cycling. He now complains of a dull pain in the upper abdomen. His last meal was 5 hours ago, but he had drunk several beers within the immediate hour before the accident. His medical and surgical histories are unremarkable. He has been a heavy drinker for the last 10 years. A full blood count, renal functions and electrolytes, clotting screen, serum glucose and ECG are all normal.
The FAST scan shows heterogeneous hyperechoic fluid within the gallbladder. No other abnormalities are seen.
You remember that diagnostic laparoscopy is not routinely recommended in blunt abdominal trauma.
There is an enlarged hydropic gallbladder measuring 8.0 × 6.1 cm with hypodense fluid, extravasated contrast within the lumen and an intraluminal hematoma extending into and distending the gallbladder neck. There is no mass effect. No evidence of other injury is seen.
The diagnostic peritoneal lavage is negative for evidence of intraperitoneal bleeding.