Liver Rupture – Causes, Symptoms and Treatment
A liver rupture is a tear or laceration of the liver, most commonly caused by blunt abdominal trauma. It is a medical emergency with a risk of life-threatening internal bleeding.
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A liver rupture is a tear or laceration of the liver, most commonly caused by blunt abdominal trauma. It is a medical emergency with a risk of life-threatening internal bleeding.
What is a Liver Rupture?
A liver rupture refers to a tear or laceration of the liver tissue. The liver is the largest internal organ in the human body and is highly vascular, meaning it receives a rich blood supply. A rupture can lead to massive internal bleeding and therefore represents a life-threatening medical emergency. Liver ruptures can be classified as subcapsular (bleeding occurs beneath the liver capsule without a full-thickness tear) or as a complete rupture, where the capsule is torn and blood flows freely into the abdominal cavity.
Causes
Liver ruptures most commonly result from external trauma, though they can occasionally occur due to underlying liver disease:
- Blunt abdominal trauma: The most common cause, including road traffic accidents, falls from height, and sports injuries
- Penetrating injuries: Stab wounds or gunshot wounds to the abdomen
- Spontaneous rupture: Rare; may occur in patients with liver conditions such as liver cancer, hepatic haemangioma, or during pregnancy as part of HELLP syndrome
- Iatrogenic causes: Very rarely as a complication of medical procedures such as liver biopsy
Symptoms
The symptoms of a liver rupture depend on the severity of the injury and the extent of bleeding:
- Severe pain in the right upper abdomen
- Pain radiating to the right shoulder (due to diaphragmatic irritation)
- Abdominal rigidity and guarding (signs of an acute abdomen)
- Signs of shock: low blood pressure, rapid heart rate, pallor, dizziness, or loss of consciousness
- Bruising of the abdominal wall or rib fractures as indicators of trauma
Diagnosis
Diagnosis of a liver rupture is carried out in the emergency department and involves several steps:
- Physical examination: Palpation of the abdomen and assessment of guarding or tenderness
- Ultrasound (FAST exam): Initial imaging method to detect free fluid in the abdominal cavity
- Computed tomography (CT scan): Gold standard for accurately assessing the extent and location of the injury
- Blood tests: Full blood count, coagulation parameters, and liver enzymes (AST, ALT, bilirubin)
- Classification: Liver injuries are graded on the AAST scale (American Association for the Surgery of Trauma), ranging from Grade I (minor) to Grade V (severe)
Treatment
Treatment depends on the severity of the injury and the overall condition of the patient:
Conservative Management
In haemodynamically stable patients with lower-grade injuries (Grade I-III), non-operative management is often appropriate. This includes:
- Inpatient monitoring in an intensive care unit
- Regular monitoring of blood pressure, heart rate, and laboratory values
- Bed rest and restricted physical activity
- Blood transfusions if required
Interventional Treatment
In cases of ongoing bleeding, minimally invasive techniques may be used:
- Angioembolisation: Targeted blocking of bleeding vessels via a catheter
Surgical Treatment
Severe injuries (Grade IV-V) or haemodynamic instability require emergency surgery:
- Damage control surgery: Emergency intervention to control bleeding with temporary wound closure
- Partial liver removal (hepatic resection) in severe cases
- Suturing of lacerations
Prognosis
The prognosis depends strongly on the severity of the injury, the general condition of the patient, and the speed of medical intervention. Minor liver lacerations generally heal well with conservative treatment. Severe injuries are associated with a higher mortality rate. Possible complications include infection, bile leaks, formation of liver haematomas, and organ failure.
References
- Stassen N.A. et al. - Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. Journal of Trauma and Acute Care Surgery, 2012.
- Tinkoff G. et al. - American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. Journal of the American College of Surgeons, 2008.
- World Health Organization (WHO) - Emergency Trauma Care Guidelines, 2021.
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