What is a liver rupture?
A liver rupture is always an emergency that doctors must treat immediately. Liver rupture usually occurs as a result of serious injuries, such as those caused by a traffic accident. The most common cause is blunt force trauma to the abdomen. The tissue and blood vessels of the liver can rupture and large quantities of blood can leak out of the vital detoxification organ. A liver rupture is very dangerous due to bleeding into the abdominal cavity. Doctors must treat the injury immediately and stop the bleeding – otherwise there is a risk to life.
A liver rupture is noticeable through various symptoms, usually pain in the right upper abdomen and a tightening of the abdominal wall. The abdominal muscles are tense and the abdominal wall feels hard. Liver rupture can lead to hemorrhagic shock (circulatory failure), which is life-threatening.
Doctors treat liver rupture conservatively in the majority of cases, but occasionally by means of surgery, which must be performed as soon as possible. They try to stop the bleeding. The prognosis for a liver laceration depends on the severity and size of the laceration. However, mortality is high in the case of severe liver trauma.
Liver rupture – frequency and age
Exact figures on the frequency of liver rupture are not known. In any case, liver rupture is very rare as an isolated injury. Liver rupture usually affects people who have suffered many other (sometimes serious) injuries. Experts speak of a polytrauma.
Such multiple injuries often occur in accidents, for example in a car or due to a fall from a great height. Experts estimate that the liver is injured in around five percent of people with blunt abdominal trauma. In most cases, however, other organs, tissues and structures have been damaged by the accident. These can be, for example, the spleen, ribs or the brain. In principle, a liver rupture can affect people of any age and gender.
Liver rupture: usually caused by accidents
In the majority of cases, the liver rupture is caused by the effect of blunt force on the abdominal cavity. With this blunt abdominal injury, the skin remains intact. The causes of liver rupture are usually accidents, for example with a car, truck, motorcycle, bicycle or as a pedestrian. Accidents during sport or at work are also possible causes. This is often due to falls from a great height, for example from scaffolding or when climbing or mountaineering. Blows from boxing or martial arts can also cause blunt abdominal trauma and put the liver at risk. In children, a liver rupture can indicate violence and abuse.
There are also penetrating abdominal injuries in which the skin is punctured. Such injuries can be caused, for example, by a knife, a bullet from a weapon, flying objects in an explosion or impalement with an object. Very rarely, a medical procedure, such as a liver biopsy, is also the cause of liver rupture.
After an accident, most of those affected not only have a liver rupture, but also other injuries. Doctors speak of a polytrauma. Examples of such concomitant injuries are
- Rib fractures
- Pulmonary contusion (lung contusion)
- Spleen rupture
- Injuries to the extremities (bone fractures)
- Craniocerebral trauma
Liver diseases can also promote a rupture in the liver if the organ has already been damaged and weakened by years of illness.
Symptoms: Liver rupture
A liver rupture can cause various symptoms. The most important are:
- Pain in the right upper abdomen – the pain can radiate into the right shoulder.
- Defensive tension – the abdominal muscles are tense and the abdominal wall feels hard when a doctor presses on it.
- Increase in body temperature
- Hemorrhagic shock due to internal bleeding with a drop in blood pressure and rapid heartbeat – up to circulatory failure and cardiac arrest
A liver rupture can be life-threatening, depending on its severity. Doctors must therefore treat the disease immediately and stop the internal bleeding. Only then do affected persons have a chance of survival.
Liver rupture: Diagnosis with us
The diagnosis of liver rupture begins – if a patient is conscious after an accident – with questions about the symptoms and the circumstances of the accident. These questions are important, for example:
- What complaints do you have exactly?
- How long have they existed?
- Is there a triggering event, such as a fall or a blow to the stomach during sport?
- How severe are the symptoms?
- Where exactly would you localize the complaints?
- Do you have any known underlying illnesses, such as liver disease?
- Are you pregnant and in which month?
- Are you taking any medications? If yes: Which and since when?
This is usually followed by a physical examination, during which we look for external injuries such as bruises or belt marks. Sensitivity to pressure pain in certain areas of the body and defensive tension in the abdomen can also be determined by palpation.
A blood test is also standard. In the event of a liver rupture, the number of white blood cells increases rapidly (leukocytosis). The liver values can provide further indications of a liver injury. For example, aspartate aminotransferase (AST or ASAT) and alanine aminotransferase (ALT or ALAT) may be elevated. In addition, the levels of red blood cells (erythrocytes, hemoglobin, hematocrit) are usually reduced.
We also always monitor the vital parameters: Blood pressure, heart rate, respiration and body temperature. In this way, hemorrhagic shock due to internal bleeding can be detected at an early stage.
Imaging procedures provide further information in the event of a liver rupture. To be used:
Liver rupture: degrees of severity
Experts classify liver rupture into five grades (according to Moore) depending on the degree of severity – grade 3 and above indicates severe liver trauma.
- Grade 1: The liver capsule is torn or defective, the tissue is injured to a depth of less than one centimeter.
- Grade 2: The liver tissue is torn one to three centimeters, a hematoma of less than ten centimeters has formed below the capsule and there is a penetrating injury.
- Grade 3: The tear in the liver tissue is more than three centimeters, the hematoma below the capsule is larger than ten centimeters and there is a penetrating injury.
- Grade 4: A liver lobe is torn and a hematoma of more than three centimeters has formed within the liver. In addition, the portal vein or a main branch is injured.
- Grade 5: Both lobes of the liver show extensive injuries. In addition, hepatic veins are torn out of the vena cava or the vena cava is injured behind the liver.
It is important that doctors recognize and treat the liver rupture as quickly as possible in order to stop the bleeding into the abdominal cavity.
Liver rupture: prevention, early detection, prognosis
There are no known specific measures to prevent liver rupture. However, liver rupture occurs in the context of traffic accidents involving two-wheelers. Therefore, always protect yourself well with the right clothing and other protective measures when you are out and about on the road on your bike, e-bike, motorcycle or scooter. To prevent sports and occupational accidents, you should also make sure you have good protective equipment.
There are no special measures for the early detection of liver rupture. The general advice is therefore to seek medical advice after any accident during leisure or sport. This also applies if you only experience mild or no symptoms. And if you have any complaints, it is always advisable to see a doctor anyway. In the event of traffic accidents, the emergency services are usually on site quickly.
Course and prognosis of a liver rupture
A liver rupture is a very dangerous injury that can be fatal due to internal bleeding and severe blood loss. This leads to shock and cardiovascular failure with cardiac arrest. A severe liver rupture is still associated with a high mortality rate. Treatment as quickly as possible is therefore always important for the course and prognosis. The severity of the liver rupture also plays a role. The more severe the liver rupture, the less favorable the prognosis.
If the bile ducts are also injured, bile can enter the abdominal cavity and cause peritonitis. In addition, tissue can die (necrosis) and abscesses can form.
Liver rupture: treatment usually involves surgery
Liver ruptures must be treated as quickly as possible in hospital, as doctors must recognize, assess and stop bleeding in the abdominal cavity. This is usually achieved conservatively, but occasionally only as part of an operation, which is performed via a large abdominal incision. Conservative treatment without surgery is usually possible, for example in children.