. A new manual of surgery, civil and military. e liver, or from penetrating wounds. The symptoms of rupture of the liver are those of internal hemorrhage andsevere shock, such as extreme pallor and cold skin, feeble and rapid pulse,sighing respiration; the abdomen becomes swollen and tympanitic and some-times there is dullness from the collection of blood. Often there is vomiting,thirst and syncope. 534 SURGERY OF THE GALL BLADDER AND LIVER Treatment. The treatment should be directed toward the control ofhemorrhage as soon as possible and to prevent the retention of bile in theperitoneal cavit
. A new manual of surgery, civil and military. e liver, or from penetrating wounds. The symptoms of rupture of the liver are those of internal hemorrhage andsevere shock, such as extreme pallor and cold skin, feeble and rapid pulse,sighing respiration; the abdomen becomes swollen and tympanitic and some-times there is dullness from the collection of blood. Often there is vomiting,thirst and syncope. 534 SURGERY OF THE GALL BLADDER AND LIVER Treatment. The treatment should be directed toward the control ofhemorrhage as soon as possible and to prevent the retention of bile in theperitoneal cavity on account of its liability to cause cholemia. If from the site of injury it is thought that the injury to the liver is in theleft lobe, or is undetermined, it is well to make a median incision. In wounds of the right lobe a longitudinal incision is made through theouter edge of the right rectus abdominis muscle and then, if found necessary,this may be converted into the S -shaped incision, as suggested by Bevan,or into the Robson L, Liver with Wound Partially Sutured. (Frank.) Wounds of the liver may be treated by suture or cautery or by gauzetampon, or by suturing a piece of sterile gauze down upon the bleeding surface. In the majority of cases a little pressure by means of a gauze pad for afew minutes will control the hemorrhage. In some cases it may be necessaryto make continuous pressure over the bleeding surface. This may be done bysuturing a piece of iodoform gauze over the bleeding surface by a few catgutstitches and bringing one end up through the abdominal wall. The gauze willmake continuous pressure and the stitches will prevent the displacement ofthe gauze should the patient cough or vomit. The catgut will be absorbed ina few days so that the gauze may then be readily removed. Bleeding may alsobe controlled by suturing the liver, using a non-cutting needle threaded withcatgut. The sutures are passed directly through the liver substance, then SURGERY OF
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