CT-Defined diagnosis and laparoscopic management of isolated liver and gallbladder injury with hemobilia after penetrating trauma: a case report

Penetrating gallbladder injury is rare and usually occurs with associated intra-abdominal injury. In hemodynamically responsive trauma patients, distinguishing hemobilia from hollow viscus or other adjacent organ injury may be challenging, and multiphasic contrast-enhanced computed tomography (CT) can play an important role in clarifying the source of bleeding and guiding management. A 28-year-old male presented following a stab wound to the right upper quadrant with initial hemodynamic instability that resolved with resuscitation. CT demonstrated a segment IVb liver laceration extending into the gallbladder, with arterial-phase contrast extravasation into the gallbladder lumen and progressive venous-phase tracking through the biliary system into the duodenum. This phase-dependent pattern localized the bleeding source to the gallbladder and indicated hemobilia rather than hollow viscus injury. The patient underwent fully laparoscopic exploration, methylene blue instillation to exclude gastrointestinal perforation, and laparoscopic cholecystectomy. No additional injuries were identified. The key operative steps are illustrated in the accompanying video. Recovery was uneventful, and the patient was discharged on postoperative day 2. In selected hemodynamically stable patients with isolated penetrating hepatobiliary injury, multiphasic CT may help localize the bleeding source and support single-stage laparoscopic management when gallbladder-origin hemobilia is identified without additional injuries.