図１〜図３と図７〜図９は省略．図４〜図６の胆嚢の漿膜下浮腫または壁内血腫（↑）は胆嚢損傷を示唆する．下段の翌日のCTでは肝周囲に相当量の腹水（※）が出現し，胆嚢壁所見（↑）はややdensityが高くなっており，壁内血腫であろう．手術（図A）で胆嚢の肝床部からの剥離（△），胆嚢穿孔による胆汁漏出と壊死性胆嚢炎（▲）を認め，胆嚢摘出術が施行された．

参考症例（Plain CT，外傷性出血性胆嚢炎）：数時間前に腹部を殴られ右季肋部痛を訴えて来院した．体温：37.0℃，右季肋部に圧痛を認めた．
胆嚢が腫大している．↑のwater densityの部分は漿膜下浮腫を示し，胆嚢内には血腫を示唆する高濃度の内容物（▲）を認め，外傷性出血性胆嚢炎と診断した．手術で同所見が確認された．

文献考察１）：胆嚢損傷のCT所見（表１）
Radiographics. 2004 Sep-Oct;24(5):1381-95.
Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis.
Gupta A, Stuhlfaut JW, Fleming KW, Lucey BC, Soto JA.

Injuries of the pancreas, gallbladder, and bile ducts due to blunt trauma are relatively uncommon and difficult to detect but are associated with high morbidity and mortality, especially if diagnosis is delayed. Accurate and early diagnosis is imperative, and imaging plays a key role in detection. Knowledge of the mechanisms of injury, the types of injuries, and the roles of various imaging modalities is essential for prompt and accurate diagnosis. Early recognition of disruption of the main pancreatic duct is important because such disruption is the principal cause of delayed complications. Computed tomography (CT) can demonstrate pancreatic parenchymal injuries and complications such as abscess, fistula, pancreatitis, and pseudocyst. CT findings can also suggest disruption of the pancreatic duct; however, the ability of CT to indicate this finding depends on the degree of parenchymal injury. Magnetic resonance (MR) cholangiopancreatography allows direct imaging of the pancreatic duct and sites of disruption. Gallbladder injuries can be detected with CT, ultrasonography, hepatobiliary scintigraphy, or MR cholangiopancreatography. CT findings include a collapsed gallbladder, wall thickening, inhomogeneous mural enhancement, and pericholecystic fluid. Bile duct injuries can be suggested with CT, which may show ascites and associated liver injuries, and can be confirmed with hepatobiliary scintigraphy. PMID: 15371615（full text）

文献考察２）：170例の検討（表２）
J Trauma. 1995 Sep;39(3):576-80.
Blunt gallbladder injuries: presentation of twenty-two cases with review of the literature.
Sharma O.

Blunt injuries to the gallbladder are very uncommon, whereas penetrating gallbladder trauma occurs more frequently. Over the last 19-year period through 1994, 22 cases with blunt gallbladder trauma were treated. Avulsion (partial or complete) and contusion were observed in 10 cases each (45%). Perforation of the gallbladder and traumatic cholecystitis with necrosis were seen in one case each. Associated intra-abdominal trauma was present in 100% of the cases and accounted for both mortalities. Gallbladder injury was diagnosed after celiotomy, except for one case that was diagnosed and treated nonoperatively. Based on the experiences gained herein and an extensive review of the literature, a classification scheme for gallbladder trauma and its treatment is presented.PMID: 7473927