Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
The Abdomen
Laparotomy and Abdominal Trauma
Labarotomy
Abdominal trauma
Acute Abdominal Conditions
Assessment and diagnosis
Intestinal obstruction
Peritonitis
Stomac and duodenum
Gallbladder
Appendix
Abdominal Wall Hernia
Groin hernia
Surgical repair of inguinal hernia
Surgical repair of femoral hernia
Surgical treatment of strangulated groin hernia
Surgical repair of umbilical and para-umbilical hernia
Surgical repair of epigastric hernia
Incisional hernia
Urinary Tract and Perineum
The urinary bladder
The male urethra
The perineum
Abdominal Trauma
 


> RUPTURED SPLEEN
> LACERATION OF THE LIVER
> SMALL INTESTINE
> COLON
> RETROPERITONEUM
> RUPTURE OF THE BLADDER
> MANAGEMENT OF RUPTURED
> BLADDER


LACERATION OF THE LIVER

Technique

:: Through a midline incision, examine the liver and gallbladder. Small wounds may have stopped bleeding by the time of operation and should not be disturbed.
:: For moderate wounds or tears that are not bleeding, do not suture or debride the liver. If a moderate wound is bleeding, remove all devitalized tissue and suture the tear with 0 chromic mattress stitches on a large round-bodied needle (Figures 6.24, 6.25). First, place overlapping mattress stitches on both sides of the wound (Figures 6.26, 6.27). Then suture the two sides together (Figure 6.28).
Figure 6.24
Figure 6.24
Figure 6.25
Figure 6.25
Figure 6.26
Figure 6.26
Figure 6.27
Figure 6.27
Figure 6.28
Figure 6.28
:: If the laceration is large, it should not be sutured. Ligate individual vessels or pack the laceration with a long gauze roll soaked in warm saline. The liver pack should be removed after about 48 hours by a surgical specialist, at repeat laparotomy with the patient under general anaesthesia. Make arrangements for referral of such a patient as soon as condition permits.


> RUPTURED SPLEEN
> LACERATION OF THE LIVER
> SMALL INTESTINE
> COLON
> RETROPERITONEUM
> RUPTURE OF THE BLADDER
> MANAGEMENT OF RUPTURED
> BLADDER



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  Kep Points  
Liver injuries follow blunt trauma to the right upper quadrant of the abdomen and may result in significant bleeding


Many liver injuries stop bleeding spontaneously and you should not suture them as this may result in significant bleeding which is difficult to stop


 
Large liver lacerations should not be closed; bleeding vessels should be ligated and the liver defect packed with omentum or, if this is unsuccessful, with gauze


  
A large drain is indicated in all patients with liver injuries. It should be removed after about 48 hours unless bile continues to drain.