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Bursting Injuries of the Liver: A Complex Surgical Challenge

Bursting Injuries of the Liver: A Complex Surgical Challenge Abstract BURSTING injuries of the liver present one of the most challenging problems encountered in the field of surgery. When a sudden, severe force is applied to a fluidfilled, sinusoidal, encapsulated mass, the force is dissipated as hydrokinetic energy and to a certain extent is governed by Pascal's principle, ie, it is transmitted in all directions and acts with the same force on all equal surfaces. A turgid organ, such as the liver, responds by bursting with an explosive violence that severely damages the internal architecture and manifests itself on various surfaces by stellate or linear crevasses. This kind of injury of the liver is unique and presents certain problems that are entirely different from those encountered in most liver injuries. The burst injury is characterized by profound shock, profuse hemorrhage, massive hemoperitoneum, pulpefaction of liver parenchyma, extravasation of bile, and metabolic and hematologic deficiencies. Multiple skeletal and soft tissue trauma References 1. Carey, L.C., and Worman, L.W.: Explosion Injury of the Liver From Intraparenchymal Hemorrhage , J Trauma 6:48, 1966.Crossref 2. Glenn, F.; Mujahed, Z.; and Grafe, W.R.: Graded Trauma in Liver Injury , J Trauma 6:133, 1966.Crossref 3. Goldsmith, N.A., and Woodburne, R.T.: The Surgical Anatomy Pertaining to Liver Resection , Surg Gynec Obstet 105:310, 1957. 4. Healey, J.E., Jr.: Clinical Anatomic Aspects of Radical Hepatic Surgery , J Int Coll Surg 22:542, 1954. 5. Healey, J.E., Jr.; Schroy, P.C.; and Sorensen, R.J.: The Intrahepatic Distribution of the Hepatic Artery in Man , J Int Coll Surg 20:133, 1953. 6. Marshall, L.W.: Rupture of the Liver; Plugging of the Pulmonary Artery With Hepatic Substance , Lancet 1:197, 1874. 7. Pringle, J.H.: Notes on the Arrest of Hepatic Hemorrhage Due to Trauma , Ann Surg 48:541, 1908.Crossref 8. Mikesky, W.E.; Howard, J.M.; and De Bakey, M.E.: Injuries of the Liver in 300 Consecutive Patients , Int Abst Surg 103:323, 1956. 9. Madding, G.F., and Kennedy, P.A.: Trauma to the Liver , Philadelphia: W. B. Saunders Co., 1965. 10. Ravdin, I.S., in discussion of Shaftan, G.W.; Gliedman, M.L.; and Cappelletti, R.R.: Injuries of the Liver: A Review of 111 Cases , J Trauma 3:72, 1963. 11. Madding, G.F.: Injuries of the Liver , Arch Surg 70:748, 1955.Crossref 12. Campbell, E., and Whitfield, R.: Emergency Management of Injuries of the Head and Spine , Surg Clin N Amer 36:1295, 1956. 13. Sparkman, R.S., and Fogelman, M.J.: Wounds of the Liver , Ann Surg 139:690, 1954.Crossref 14. Boyce, F.F., and McFetridge, E.M.: Autolysis of Tissue in Vivo: An Experimental Study With Its Clinical Application in the Problem of Trauma to the Liver , Arch Surg 34:977, 1937.Crossref 15. Orr, T.G., and Helwig, F.C.: Liver Trauma and the Hepatorenal Syndrome , Ann Surg 110:682, 1939.Crossref 16. Sandblom, P.: Hemorrhage Into Biliary Tract Following Trauma: "Traumatic Hemobilia," Surgery 24:271, 1948. 17. Vasko, J.S., and Scott, W.H.: Acute Renal Failure From Massive Intrahepatic Hematoma Compressing the Inferior Vena Cava , Ann Surg 163:144, 1966.Crossref 18. Stone, F.A., et al: Treatment of Exsanguinating Rupture of the Right Lobe of the Liver by Ligation of the Main Hepatic Artery , Ann Surg 162:933, 1965.Crossref 19. McClelland, R.N., and Shires, T.: Management of Liver Trauma in 259 Consecutive Patients , Ann Surg 161:248, 1965.Crossref 20. Lin, T.Y.; Chen, K.M.; and Liu, T.K.: Total Right Hepatic Lobectomy for Primary Hepatoma , Surgery 48:1048, 1960. 21. Byrd, W.M., and McAfee, D.K.: Emergency Hepatic Lobectomy in Massive Injury of the Liver , Surg Gynec Obstet 113:103, 1961. 22. Pack, G.T., et al: Regeneration of Human Liver After Major Hepatectomy , Surgery 52:617, 1962. 23. McClelland, R.; Shires, T.; and Poulos, E.: Hepatic Resection for Massive Trauma , J Trauma 4:282, 1964.Crossref 24. Judd, D.R., and Moore, T.C.: Right Hepatic Lobectomy for Massive Liver Trauma , Ann Surg 163:149, 1966.Crossref 25. Quattlebaum, J.K., and Quattlebaum, J.K., Jr.: Technique of Hepatic Lobectomy , Ann Surg 149: 648, 1959.Crossref 26. Merendino, K.A.; Dillard, D.H.; and Cammock, E.E.: Surgical Biliary Decompression in the Management of Liver Trauma , Surg Gynec Obstet 117:285, 1963. 27. Mays, E.T.: Management of Severe Liver Trauma, Surg Gynec Obstet, to be published. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Bursting Injuries of the Liver: A Complex Surgical Challenge

Archives of Surgery , Volume 93 (1) – Jul 1, 1966

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Publisher
American Medical Association
Copyright
Copyright © 1966 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1966.01330010094013
Publisher site
See Article on Publisher Site

Abstract

Abstract BURSTING injuries of the liver present one of the most challenging problems encountered in the field of surgery. When a sudden, severe force is applied to a fluidfilled, sinusoidal, encapsulated mass, the force is dissipated as hydrokinetic energy and to a certain extent is governed by Pascal's principle, ie, it is transmitted in all directions and acts with the same force on all equal surfaces. A turgid organ, such as the liver, responds by bursting with an explosive violence that severely damages the internal architecture and manifests itself on various surfaces by stellate or linear crevasses. This kind of injury of the liver is unique and presents certain problems that are entirely different from those encountered in most liver injuries. The burst injury is characterized by profound shock, profuse hemorrhage, massive hemoperitoneum, pulpefaction of liver parenchyma, extravasation of bile, and metabolic and hematologic deficiencies. Multiple skeletal and soft tissue trauma References 1. Carey, L.C., and Worman, L.W.: Explosion Injury of the Liver From Intraparenchymal Hemorrhage , J Trauma 6:48, 1966.Crossref 2. Glenn, F.; Mujahed, Z.; and Grafe, W.R.: Graded Trauma in Liver Injury , J Trauma 6:133, 1966.Crossref 3. Goldsmith, N.A., and Woodburne, R.T.: The Surgical Anatomy Pertaining to Liver Resection , Surg Gynec Obstet 105:310, 1957. 4. Healey, J.E., Jr.: Clinical Anatomic Aspects of Radical Hepatic Surgery , J Int Coll Surg 22:542, 1954. 5. Healey, J.E., Jr.; Schroy, P.C.; and Sorensen, R.J.: The Intrahepatic Distribution of the Hepatic Artery in Man , J Int Coll Surg 20:133, 1953. 6. Marshall, L.W.: Rupture of the Liver; Plugging of the Pulmonary Artery With Hepatic Substance , Lancet 1:197, 1874. 7. Pringle, J.H.: Notes on the Arrest of Hepatic Hemorrhage Due to Trauma , Ann Surg 48:541, 1908.Crossref 8. Mikesky, W.E.; Howard, J.M.; and De Bakey, M.E.: Injuries of the Liver in 300 Consecutive Patients , Int Abst Surg 103:323, 1956. 9. Madding, G.F., and Kennedy, P.A.: Trauma to the Liver , Philadelphia: W. B. Saunders Co., 1965. 10. Ravdin, I.S., in discussion of Shaftan, G.W.; Gliedman, M.L.; and Cappelletti, R.R.: Injuries of the Liver: A Review of 111 Cases , J Trauma 3:72, 1963. 11. Madding, G.F.: Injuries of the Liver , Arch Surg 70:748, 1955.Crossref 12. Campbell, E., and Whitfield, R.: Emergency Management of Injuries of the Head and Spine , Surg Clin N Amer 36:1295, 1956. 13. Sparkman, R.S., and Fogelman, M.J.: Wounds of the Liver , Ann Surg 139:690, 1954.Crossref 14. Boyce, F.F., and McFetridge, E.M.: Autolysis of Tissue in Vivo: An Experimental Study With Its Clinical Application in the Problem of Trauma to the Liver , Arch Surg 34:977, 1937.Crossref 15. Orr, T.G., and Helwig, F.C.: Liver Trauma and the Hepatorenal Syndrome , Ann Surg 110:682, 1939.Crossref 16. Sandblom, P.: Hemorrhage Into Biliary Tract Following Trauma: "Traumatic Hemobilia," Surgery 24:271, 1948. 17. Vasko, J.S., and Scott, W.H.: Acute Renal Failure From Massive Intrahepatic Hematoma Compressing the Inferior Vena Cava , Ann Surg 163:144, 1966.Crossref 18. Stone, F.A., et al: Treatment of Exsanguinating Rupture of the Right Lobe of the Liver by Ligation of the Main Hepatic Artery , Ann Surg 162:933, 1965.Crossref 19. McClelland, R.N., and Shires, T.: Management of Liver Trauma in 259 Consecutive Patients , Ann Surg 161:248, 1965.Crossref 20. Lin, T.Y.; Chen, K.M.; and Liu, T.K.: Total Right Hepatic Lobectomy for Primary Hepatoma , Surgery 48:1048, 1960. 21. Byrd, W.M., and McAfee, D.K.: Emergency Hepatic Lobectomy in Massive Injury of the Liver , Surg Gynec Obstet 113:103, 1961. 22. Pack, G.T., et al: Regeneration of Human Liver After Major Hepatectomy , Surgery 52:617, 1962. 23. McClelland, R.; Shires, T.; and Poulos, E.: Hepatic Resection for Massive Trauma , J Trauma 4:282, 1964.Crossref 24. Judd, D.R., and Moore, T.C.: Right Hepatic Lobectomy for Massive Liver Trauma , Ann Surg 163:149, 1966.Crossref 25. Quattlebaum, J.K., and Quattlebaum, J.K., Jr.: Technique of Hepatic Lobectomy , Ann Surg 149: 648, 1959.Crossref 26. Merendino, K.A.; Dillard, D.H.; and Cammock, E.E.: Surgical Biliary Decompression in the Management of Liver Trauma , Surg Gynec Obstet 117:285, 1963. 27. Mays, E.T.: Management of Severe Liver Trauma, Surg Gynec Obstet, to be published.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1966

References