The problems of closed liver injuries

Abstract

From East Glamorgan Hospital, Church Village, Nr. Pontypridd SYNOPSIS Because laceration of the liver is a condition which the surgeon is rarely called upon to treat, 36 cases of liver injury admitted bAtween 1926 and 1958 have been reviewed and the results compared with those of other authors. As well as discussing the incidence of this injury and its relation to age, sex, and pathology, the surgical management is outlined. The greatest single factor which has assisted the surgeon is transfusion of whole blood. Early operation is considered advisable, and suturing is preferred in repairing damage to the liver substance and achieving haemostasis. Nevertheless, the mortality rate is high, in this series 60 %, which compares favourably with that of other series. It is notable that patients operated on have a better chance of survival than those not operated upon.

Improved mortality in the management of liver injuries

“…Mikesky, Howard, and DcBakcy (1956) noted a mortality of tj per cent whcn only the liver was damaged, whereas 67 per cent of patients died who had injuries to five or more other viscera. (Mills, 1961 ;Hanna, Bell, and Cochran, 1965), Sweden (Hellstrom, 1961), and Australia (Little, 1965; Thomas and Wright, 1968), in which blunt inpries predominate. It is unlikely that surgeons dealing mostly with blunt injuries can duplicate the low mortality of those dealing with stab wounds.…”

Angiography in Rupture of the Liver

“…The true extent and type of hepatic trauma can hardly be assessed at operation, as experienced in 3 of the present cases and stressed by previous investigators (MILLS 1961, SOUIEIM 1963. The complicated anatomy of the liver implies that different types of damage may be expected.…”

“…In some series the liver appears to be equally frequently or more frequently damaged than the spleen (VANCE 1928, ALLEN 1931, MILLS 1961. The mortality in hepatic rupture is extremely high, and exceeds that in rupture of the kidneys and the spleen.…”

“…Hepatic rupture is usually caused by major blunt or penetrating abdominal trauma. It should, however, be noted that in cases with minor trauma rupture may result when the liver is enlarged (MILLS 1961) ; spontaneous rupture of the liver has been reported in pregnancy (SANES & KAMINSKI 1946).…”

“…A minor haematoma may gradually enlarge and result in severe complications; days or weeks later it may rupture into the peritoneal cavity (MILLS 1961) or biliary tree (SANDBLOM 1948, WHELAN & GILLESPIE 1965. Again it may become infected and develop into an abscess.…”