Giant biloma as a result of a blunt abdominal trauma: A case report.

A 58-year-old man with a history of a heavy alcohol intake was admitted to hospital for a 3-weeks history of abdominal discomfort, nausea, vomiting and an increased abdominal girth that appeared progressively after an abdominal trauma due to an accidental fall. On physical examination, jaundice was present and the abdomen was distended with no tenderness on palpation. Laboratory studies showed an increased white-cell count, an elevated C-reactive protein and abnormal liver-function tests. Abdominal ultrasonography showed a large fluid collection in the right side of the abdomen. An abdominal computed tomography scan revealed a gallbladder perforation communicating to a big subcapsular hepatic biloma of 9.5 by 25.0 by 35.0 centimeters, which was compressing the liver and other intraabdominal organs. Finally, our patient underwent an open cholecystectomy with drainage of the biloma, and a partial resection of the Glisson's capsule. Macroscopic and microscopic examination of the resected specimens confirmed the diagnosis of traumatic gallbladder perforation. Gallbladder traumatic injury is a rare entity. The diagnosis represents a challenge because of its low incidence, its association with other lesions of vital organs and the nonspecific and insidious symptoms that can produce. Treatment depends on the type and severity of the damage caused; nevertheless, cholecystectomy remains the treatment of choice in patients with rupture or avulsion of the gallbladder. To our knowledge, this is the first report in the English literature of an isolated blunt traumatic gallbladder injury that was associated with the development of a large biloma.