Traumatic Rupture of the Liver Without Penetrating Wounds

Wright, Louis T.

doi:10.1001/archsurg.1947.01230070624001

Cited by 23 publications

(5 citation statements)

References 17 publications

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“…figures compare closely with those of Edler (1887) and Thorlakson and Hay (1929), who in each case gave a figure of 1 in 1,300, whereas Wright, Prigot, and Hill (1947) found 27 cases occurring in 34,000 cases admitted to the Harlem Hospital between 1953 and 1945, a figure of 1 in 1,259.…”

supporting

confidence: 86%

The problems of closed liver injuries

Mills¹

1961

Gut

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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.

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supporting

confidence: 86%

The problems of closed liver injuries

Mills¹

1961

Gut

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“…The potential usefulness of sampling of peritoneal fluid was first described by Saloman 17 and later reported by Neuhof and Cohen 18 in the diagnosis of several intra‐abdominal conditions. Wright aspirated four quadrants in an effort to apply this technique to abdominal trauma 3 but its use was accompanied by a high false negative rate 1 , 5 , 6 . Following animal studies by Canizaro 19 , Root introduced peritoneal lavage as a method which offered an obvious improvement in diagnosis 6 .…”

Section: Discussionmentioning

confidence: 99%

“…The inaccuracy of clinical diagnosis in those patients with blunt abdominal trauma can be as high as 40 to 45 per cent 1 , 2 . Because of this inaccuracy, many methods to improve diagnosis have been considered 3 , 5 . Diagnostic peritoneal lavage, since its introduction in 1965 by Root et al 6 , has been widely reported in the United States of America 1 , 2 , 5–8 but has received scanty review in the British literature 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic peritoneal lavage in blunt abdominal trauma

O’Malley

1986

Int J Clinical Practice

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Inaccurate clinical diagnosis still contributes to the morbidity and mortality in blunt abdominal trauma. Peritoneal lavage has contributed greatly to earlier and more accurate diagnosis. Thirty-seven patients underwent diagnostic peritoneal lavage with 92 per cent true positive findings. One false positive and no false negatives occurred. Four patients died, but none had intra-abdominal injuries. The value of this test is emphasised.

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“…2 This was in part because of the removal of bile and blood collections from the abdomen, and this practice continued for several years. [3][4][5] With the advent of nonoperative therapy, the potentially deleterious effects of large bile and blood collections are often disregarded.…”

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confidence: 99%

Prevention of Bile Peritonitis by Laparoscopic Evacuation and Lavage after Nonoperative Treatment of Liver Injuries

Franklin

Richardson

Brown

et al. 2007

The American Surgeon™

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One of the major lessons learned in the World War II experience with liver injuries was that bile peritonitis was a major factor in morbidity and mortality; the nearly uniform drainage of liver injuries in the subsequent operative era prevented this problem. In the era of nonoperative management, patients who do not require operative treatment for hemodynamic instability may develop large bile and/or blood collections that are often ignored or inadequately drained by percutaneous methods. These inadequately treated bile collections may cause systemic inflammatory response syndrome and/or respiratory distress. We present an experience with laparoscopic evacuation of major bile/blood collections that may prevent the inflammatory sequelae of bile peritonitis. Patients usually underwent operation between 3 and 5 days postinjury (range, 2–18) if CT demonstrated large fluid collections throughout the abdomen/pelvis not amenable to percutaneous drainage. Most patients had signs of systemic inflammatory response syndrome, respiratory compromise, or elevated bilirubin. The bile and retained hematoma was evacuated from around the liver and closed-suction drainage was placed. Twenty-eight patients underwent laparoscopic evacuation/lavage of bile collections (about 4% of total blunt liver injuries). The majority (75%) had Grade IV or V injury. The amount of evacuated fluid ranged from 300 to 3800 mL. Other adjunctive procedures (endoscopic retrograde pancreaticocholangiography, angiography, and laparotomy) were occasionally required. There were no complications related to the procedure. Most patients had a dramatic decline in tachycardia, temperature, white blood cell count, serum bilirubin, and pain. Respiratory failure also resolved in most patients. Large bile and/or blood accumulations are present in a subset of patients with severe liver injuries treated nonoperatively. Delayed laparoscopic evacuation of these collections prevents bile peritonitis and decreases inflammatory response and avoiding early operation, which has been implicated in increased death from hemorrhage.

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Traumatic Rupture of the Liver Without Penetrating Wounds

Cited by 23 publications

References 17 publications

The problems of closed liver injuries

The problems of closed liver injuries

Diagnostic peritoneal lavage in blunt abdominal trauma

Prevention of Bile Peritonitis by Laparoscopic Evacuation and Lavage after Nonoperative Treatment of Liver Injuries

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