Diagnosis of a liver rupture

A liver rupture is in most cases an emergency situation and therefore a very fast diagnosis is required. A liver laceration is not always easy to diagnose. In most cases, the diagnostic algorithm (sequence of examinations) is the following:

UltrasoundThe ultrasound can quickly detect free fluid, such as blood around the liver and abdomen

Therapy

A liver tear is almost exclusively treated surgically and only in very few cases conservatively, since there is always a risk of bleeding and loss of functioning liver tissue. A liver tear must be treated surgically immediately in case of bleeding.To do this, the surgeon makes an abdominal incision to gain access to the injured organ. Often only then can the full extent of the injury be determined.

The aim is to stop the blood loss by repairing large vessels and to preserve as much functioning organ tissue as possible. A frequently used primary method to stop bleeding is the so-called packing of the liver. Here the liver is wrapped in abdominal cloths and the bleeding is stopped by compression.

The abdomen is then temporarily closed again and the patient is closely monitored, especially with regard to circulation and breathing. After about 48 hours the abdomen is reopened and the sterile drapes are removed, whereby the bleeding should be stopped. Only in this second operation is the liver finally treated with sutures. In other cases, destroyed liver tissue is removed already during the first operation, destroyed blood vessels are sutured and the still functioning liver tissue is rejoined by sutures. Since a liver rupture is a serious disease, the affected person usually has to be closely monitored in the intensive care unit for a longer period of time and recovery takes several weeks.

Consequences

The most dangerous consequence of a liver rupture is initially the severe loss of blood. If larger vessels are injured, several liters of blood may bleed into the free abdominal cavity. As a result, the blood pressure of the affected person drops and dizziness and circulatory weakness can occur, which can even lead to fainting.

The discharge of bile and blood into the abdominal cavity can also lead to an inflammation, a so-called peritonitis, which is life-threatening. In any case, a ruptured liver is a serious disease that requires surgical treatment and consequently leads to a longer stay in hospital. The chance of recovery depends mainly on the patient’s age and previous illnesses, and essentially on the patient’s blood loss.

Depending on the extent of the injury and how badly the organ and large blood vessels are damaged, the mortality rate can be up to 50%. If large parts of the damaged liver tissue have to be removed, the remaining tissue may not be able to fully perform the functions of the liver, resulting in liver failure. However, since the liver has the property of regenerating itself, i.e. “re-growing”, symptoms only occur after the removal of very large parts of the liver.