LIVER, Injuries and Rupture of.
The shock and collapse should be met by absolute rest in the horizontal position, and it is wise to abstain from Morphia till the diagnosis of a rupture or laceration of the liver can be made certain where there has been no penetrating wound. As soon as evidence of hepatic injury has been rendered probable by the symptoms morphia should then be given and the abdomen should be opened without delay. Hemorrhage should be promptly controlled by clamping the portal vessel between the fingers while all clots are being removed. Wounds in the hepatic substance should be ligatured by catgut sutures of the mattress type passed deeply into the hepatic tissue and drawn tightly so as to stop haemorrhage even should the gland substance be partially cut by them. Where a ragged rent continues to bleed after deep suturing, the best procedure is to firmly pack the chasm with sterile gauze and bring the tail of the packing into the parietal wound, if the main bleeding trunk cannot be seized and ligatured separately. The peritoneal sac should be sponged with gauze
swabs moistened with saline solution.
Penetrating wounds are treated upon the same lines, and after the passage of deep mattress sutures to arrest hemorrhage the rent in the capsule should be closed by superficial stitches. Van Buren Knott's liver suture is designed to avoid tearing of the hepatic tissue, and may be employed as a preliminary to the removal of a portion of liver tissue containing a tumour.
Bayonet or dagger wounds involving the liver through the diaphragm should be dealt with through the pleural route and the thoracic cavity isolated by suturing the diaphragmatic wound to the lips of the intercostal incision.