An Unusual Presentation of Liver Laceration

Abstract

ABSTRACT:Liver is the largest solid abdominal organ with a relatively fixed position, which makes it prone to injury. Liver trauma is the second most frequent event during an abdominal trauma and is the leading cause of death (20-40%) in these cases. So it's a must to identify and treat liver trauma at the earliest for better outcome. A 22 year male was brought to casualty with history of road traffic accident. On examination, patient was drowsy but irritable with Glasgow Coma Scale (GCS) of13(E3+M6+V4). His abdominal examination was normal. Patient was admitted with the diagnosis of Traumatic brain injury and was put on treatment. After 48 hours of admission, patient became conscious and oriented with GCS of 15. He started complaining of pain abdomen. Abdominal examination revealed same findings as found at the time of presentation with additional positive shifting dullness. USG abdomen showed liver and splenic contusions with hemoperitoneum of 2000ml. Patient was posted for exploratory laparotomy because of massive hemoperitoneum. A thorough abdominal examination revealed a destructed and devascularized hepatic segments II and III (Grade IV).Physical examination of the abdomen is unreliable; drugs, alcohol and head and spinal cord injuries complicate clinical evaluation. Hence one should investigate for abdominal injuries especially liver trauma as Liver injuries present a serious risk for shock because the liver tissue is delicate and has a large blood supply and capacity. INTRODUCTION:Trauma is recognised as a serious public health problem. In fact, it is the leading cause of death and disability in the first four decades of life and is the third most common cause of death overall. 1 The liver is the largest solid abdominal organ with a relatively fixed position, which makes it prone to injury. Liver trauma is the second most frequent event during an abdominal trauma and is the leading cause of death (20-40%) in these cases. 2 So it's a must to identify and treat liver trauma at the earliest for better outcome.We report a case of unusual presentation of liver injury presented to our institution.