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July 1966

Bursting Injuries of the Liver: A Complex Surgical Challenge

Author Affiliations

From the Department of Surgery and the Price Institute of Surgical Research, University of Louisville School of Medicine, Louisville.

Arch Surg. 1966;93(1):92-106. doi:10.1001/archsurg.1966.01330010094013

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

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