Hepatic Trauma: Liver Lacerations

Every year thousands of people are severely injured in automobile accidents. Hepatic injuries and more specifically, liver lacerations are most common in auto accidents where there are decelerations injuries. Most often there is a crash and the body is thrown forward into the steering wheel. With that, the right rib cage is fractured, and the internal organs are severely injured. There may be a collapsed lung (pneumothorax), liver lacerations, and other organ damage.

Blunt or penetrating trauma is the most common cause of liver lacerations. When there is an auto accident, the blunt force of the steering wheel is focused over the 7th and 9th rib, which often fracture and the end result is a punctured or lacerated liver. The injury will be characterized by pain in the upper right quadrant of the abdomen. There may be bleeding into the peritoneal cavity which may cause enough pressure and irritation to cause pain and tenderness in all 4 quadrants of the abdomen. Upon admission to an emergency department, the physician will order X-rays to look for evidence of liver lacerations and other injuries through the verification of rib fractures. In addition to liver lacerations, there may be blunt force trauma to the liver, lungs, and kidneys, which will all have to be evaluated and addressed by the physician and or surgeon.

In an emergency situation, there may not be time to schedule a CT scan; however after the crisis is over, the physician may order a CT scan to evaluate the overall condition of the liver and other internal organs. Scanning the injured area with a CT scanner will identify areas that have been lacerated or otherwise traumatized. So much more can be seen with a CT than in an X-ray or with the trained eye of the surgeon.

After medical or surgical intervention has taken place to mend the liver laceration, the doctor may still be concerned about internal bleeding. The patient will be evaluated every 15 minutes for the first hour and every 30 minutes for the second hour. If there is still evidence of internal bleeding it will show up in the vital signs, and there may also be increased pain in the wounded area called rebound pain. Rebound pain is related to increased pressure secondary to internal bleedingthe pain gets worse instead of better after pain medications are administered.

Internal bleeding caused from liver lacerations is a medical emergency. The victim often will quickly go into hypovolemic shock caused by rapid blood loss. The body responds to hypovolemic, or in this case, more commonly known as hemorrhagic shock by lowering the blood pressure. Shock is a life threatening emergency and must be treated immediately. The source of internal bleeding must be found and corrected. This will often mean surgical intervention to repair the liver, as well as repairing any fractures that have inadvertently caused the injury. Once the repair is done, the body will start to heal itself. Platelets will form causing the wounded area to clot off to seal the wound, so that healing can take place.