Rupture or Laceration of the Liver by Non-Penetrating Trauma

In the order of frequency, injury to the abdominal organs following blunt trauma involves the kidneys, bladder, spleen, liver, and intestinal tract (Table I). Laceration of the liver occurs in from 5 to 10 per cent of patients with abdominal trauma and is about half as common as laceration of the spleen. The radiographic changes following rupture or laceration of the liver by non-penetrating trauma will be assessed in this paper. Material Twenty-six patients who had an adequate preoperative or premortem radiographic examination were selected for study. Twenty-one of these were injured in automobile accidents; 2 in falls; 2 by blows from falling objects, and 1 by a kicking horse. Technic of Examination Following admission, the standard treatment for hemorrhage, shock, and skeletal injury was carried out. The patient voided spontaneously or was catheterized ; if blood was found in the specimen, an injury to the urinary tract was assumed. If indicated, further study of the kidneys was done by intravenous urography and of the bladder by retrograde cystography. Evidence of blood in the stomach was sought by nasogastric aspiration and in the rectum by digital examination. Both chest and abdominal films were obtained when intra-abdominal injury was suspected, the extent of the examination being limited only by the clinical condition of the patient. Portable apparatus was used if necessary. Since delayed bleeding can occur following injury of the liver (2), similar to the delayed bleeding of splenic injury, the examination of the chest and abdomen was repeated if there was a change in the patient's condition. If the radiographic examination was equivocal, it was in some instances supplemented by the four-quadrant peritoneal tap as recommended by Wright, Prigot, and Hill (21) and by Moretz and Erickson (11). Radiographic Findings Radiographic signs may be divided into two categories : those which result from injury to the right thorax and abdomen, and those from torn vessels in the liver. Injury to Thorax and Abdomen Blunt trauma will be manifested by injury of the supporting structures of the thorax and chest. In unconscious patients the radiograph permits determination of the site of the major force of the trauma. In 12 of the 26 patients, fractures of the right ribs accompanied by blood in the right pleura were found. The combination of fractured right lower ribs with hemothorax in a seriously injured patient should initiate a search for other signs of liver laceration (3, 5, 6, 14, 17). Other signs of right thoracic injury were : pneumothorax in 2 cases and contusion of the lung in 2. Elevation of the right leaf of the diaphragm occurred in 5 but in only 1 was the right leaf torn. Direct injury to the chest wall with splinting or the accumulation of blood may explain the elevation of the diaphragm. Evidence of contusion of the abdominal wall over the liver was found in 5 of the 26 patients.