Carmel Sparke A RARE case of isolated traumatic gall bladder injury has prompted calls to consider the diagnosis , especially in young men with a history of alcohol abuse , according to US doctors .

Their 27-year-old patient presented to ED with abdominal pain associated with eating solid food , three days after a snowmobile accident in which he was thrown into a tree at speeds of up to 100km / h .

His abdomen was the primary impact site , but there was no loss of

consciousness . The doctors noted moderate right upper quadrant tenderness with guarding resembling localised peritonitis of the right hemiabdomen but no other signs of injury .

He had a history of alcohol-withdrawal seizures and consumed 12 drinks a week on average .

Blood tests revealed mild leukocytosis and mildly elevated transaminases , while CT of the abdomen and pelvis showed an acute tear of the gall bladder mucosa , with haematoma / biloma and intra-abdominal fluid in

the right paracolic gutter and pelvis .

Abdominal ultrasound revealed gall bladder wall thickening and pericholecystic fluid .

“ Given these findings and their correlation with recent traumatic injury , it was postulated that he had sustained an isolated blunt traumatic injury to the gall bladder ,” the doctors said .

They recommended diagnostic laparoscopy with possible cholecystectomy , but the man opted for an outpatient elective procedure and

was discharged on oral antibiotics .

Two days later , he was back in ED with worsening recurrent pain “ after his son jumped onto his abdomen ”.

This time , he agreed to surgical intervention and the doctors removed his gall bladder ; it had two patchy gangrenous areas , and pathology confirmed acute cholecystitis superimposed on chronic cholecystitis .

The patient ’ s symptoms resolved and he was discharged in a stable condition with no concerns at follow-up . Cureus 2023 ; 23 Aug .

Rachel Carter A GP has repaid $ 360,000 in Medicare claims for acupuncture after a review found he had treated up to nine patients at the same time .

The Professional Services Review ( PSR ) said the doctor was in the top 1 % of doctor claimants for items 193 , 197 and 199 .

The items attract rebates of $ 40.55 , $ 78.55 and $ 115.60 , respectively , depending on the length of the consultation , which must include a history , clinical examination , management plan and referrals for investigations where necessary .

The GP admitted he had engaged in inappropriate practice and agreed to repay the rebates after the PSR found it was unclear from his “ sometimes illegible ” progress notes whether he had examined patients , implemented management plans or met the minimum time requirements for the item claimed .

In addition , his “ practice model ” included “ seeing up to nine acupuncture patients concurrently ”, the watchdog said .

The PSR ’ s most recent update revealed that it had reclaimed more than $ 6 million in Medicare rebates in July .

Another case saw a corporate agree to pay back $ 1,160,000 after its health practitioners were found to have claimed attendance items for consultations that had not been carried out or were not needed .

And an orthopaedic surgeon agreed to repay $ 410,000 for items related to hip and knee surgery , with some of the procedures found not to be clinically indicated .

As Australian Doctor went to press , a new permanent director for the PSR had yet to be announced .