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Fig. 128.—Rupture of Liver.

period extending over eight years. Out of these, external marks of injury
were visible in three only. One of these cases was very remarkable. A young
Mahomedan male of twenty-two years was run over by a motor car, and
died within an hour. At the post-mortem examination which I held on the
day after the death I found no trace of external or internal bruising of the
abdominal wall, but the liver was crushed and the right lobe was almost

Ruptures usually involve the right lobe, and occur in the anterior
surface and the inferior border. They are ordinarily directed antero-
posteriorly or obliquely, rarely transversely, and are generally one or two
inches deep, but rarely pass through the entire substance of the organ. The
liver is lacerated more easily if it is
enlarged and fatty. In rupture of the
liver death occurs immediately from
shock and haemorrhage, especially if
the portal vein or vena cava is injured,
or it may occur within forty-eight
hours. Sometimes, life may be pro-
longed for days if the liver substance
alone is injured. A case occurred in
Agra in which a man survived five
days after the liver was ruptured.
Sometimes, recovery occurs after
slight wounds or lacerations. It is also
possible that rupture may lead to the
formation of liver abscess through sep-
tic infection. From his observations

Bauer 46 thinks that an abscess may occur from eleven days to one year after
the central rupture of the liver as the result of compression. In rare cases,
it may occur even four and ten years later. He describes a case in which a
man fell into a hole and fractured his right fifth rib. For months he com-
plained of local pain and pain on breathing, and held himself so bent that he
was ordered a corset. A year later he was suddenly taken ill with rigors
and high fever, and died two weeks later. At the necropsy a liver abscess
was found.

Gall-bladder.—Wounds and ruptures of the gall-bladder may result from
penetrating wounds or from a blow, kick, or compression with the knee, but
on account of the small size of the gall-bladder and the deep situation of the
hepatic veins these injuries are rare.

In January 1919, a case occurred, in which the upper surface of the gall-bladder
was lacerated by an ekka passing over the body.

The gall-bladder may rupture spontaneously, when distended with gall-
stones. Braithwaite 4T records such a case in which a circular perforation
about a third of an inch in diameter occurred on the posterior surface of the
fundus of the gall-bladder. Death occurs from peritonitis owing to the
effusion of blood and bile into the peritoneal cavity.

Spleen.—On account of its situation, rupture of a normal spleen is very
rare unless caused by considerable compressing force, such as the passing
of a carriage or motor car over the body, or by a crush in a railway accident,
or by a fall from a very great height; in such cases it is usually associated
with injuries to other solid organs and to the ribs overlying the spleen. A
normal spleen may sometimes be ruptured by the broken ends of a rib
which may be fractured by a severe kick or by a blow from a blunt weapon.

46,   Brit. Mcd. J"otirn March 12, 1921, Epitome, p. 43.

47.   Brit. Med. Jour, Dec. 12, IMS, p. 1,746.