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Penetrating Injuries to the Liver or Spleen

What are penetrating injuries to the liver or spleen?

Penetrating injuries are also called piercing injuries. These may be caused by anything that goes through the skin and into the body. Piercing injuries to the liver or spleen may cause a tear, cut, or bruise to the organ. Piercing injuries may also result in a severely damaged organ and internal bleeding. The liver and spleen are large organs located at the upper area of the abdomen (stomach). The liver is at the right side and the spleen is at the left. Both organs are partly protected by the lower ribs.

What causes piercing injuries to the liver or spleen?

Piercing injuries to the liver or spleen are commonly caused by gunshot wounds. Stab wounds or objects that go through the skin and into the abdomen may also cause piercing injuries. These objects may include shrapnel, spikes, broken bones, and other pointed objects.

What are the signs and symptoms of piercing injuries to the liver or spleen?

  • Abdominal pain and tenderness.
  • Bleeding, swelling, or bruising from the wound site.
  • Burned skin caused by a gun fired at close range.
  • Open wounds where the objects may have entered or exited.
  • Pain on the left shoulder.
  • Signs of shock including a fast pulse (heartbeat), low blood pressure, and pale skin.

How are piercing injuries to the liver or spleen diagnosed?

Your caregiver will do a complete check-up of your body to look for open wounds and signs of injury. Certain tests use a special dye to help organs and structures show up better. Tell caregivers if you are allergic to shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye. One or more of the following tests may be done:

  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  • Imaging tests:
    • Angiography: This test looks for problems with blood flow in your abdomen. A catheter (long, thin, bendable tube) is placed in a blood vessel in your groin. The groin is the area where your abdomen meets your upper leg. A dye is put into the catheter. Pictures are taken using an x-ray or a CT scan after the dye goes to your abdominal organs.
    • Computerized tomography scan: This is also called CT scan. A special X-ray machine uses a computer to take pictures of different areas of your abdomen and pelvis. It may be used to look at your bones, organs, and blood vessels. Before taking the pictures, you may be given dye through an IV in your vein.
    • ERCP: ERCP is also called endoscopic retrograde cholangiopancreatography. This test is done during an endoscopy to find injuries, stones, tumors, or other problems. Dye is put into the endoscopy tube.
    • Abdominal ultrasound: This test is done so caregivers can see the tissues and organs of your abdomen. Gel will be put on your abdomen and a small sensor will be moved across your abdomen. The sensor uses sound waves to send pictures of your abdomen to a TV-like screen.
    • X-rays: X-rays of different parts of your body may be taken. These may include x-rays of your chest (lungs and heart), abdomen, and pelvis (hips). X-rays may help caregivers look for broken bones, other injuries, or the presence of a foreign body inside your body.
  • Procedures:
    • Laparoscopy: Your caregiver may want to look inside your abdomen to look for bleeding and other injuries. This is done by inserting a scope into small cuts made in your abdomen. The scope is a long tube with a magnifying glass, a camera, and a light on the end.
    • Laparotomy: This is surgery to open your abdomen. Caregivers may do a laparotomy to look closely at organs and lymph nodes inside your abdomen. Tissue samples may be taken and sent to a lab for tests.
    • Peritoneal lavage: A peritoneal (per-i-toh-NEE-al) lavage (lah-VAHZH) checks the fluid in your abdomen for signs of blood, bile (fluid from your gallbladder), or stool. Caregivers put a needle or plastic tube into a small incision (cut) in your abdomen. Liquid is given through the tube into your abdomen. The fluid is removed and may be sent to a lab. This test will help caregivers know if there is a problem with one or more organs in your abdomen.

How are piercing injuries to the liver or spleen treated?

  • Watchful waiting: If your condition is stable and your injury is mild, watchful waiting may be all that is needed. Your caregiver will watch you closely for a period of time until your liver or spleen injury heals on its own. You may need to rest in bed and limit your activity.
  • Drainage: Draining may be done to clean out any old blood or bile (brownish fluid) in your abdomen. This may be done more than once.
  • Embolization: This is done to stop bleeding from an injured blood vessel. After doing an angiography, caregivers block off the bleeding by injecting a liquid, coil, or gel into the vessel.
  • Surgery: Open or laparoscopic surgery may be done to repair the injured organ. Your caregiver may use sutures (threads) to close a cut. Omentum (fat connected to the bowels) may also be put to pack and close the cut in the organ. Bleeding vessels may be stopped by applying heat or closing them with sutures. Surgery to take out all or part of the spleen or liver may be done. Sometimes, surgery to correct other problems or treat other injuries may be done first. You may need to have more than one surgery.

Where can I find more information?

Having a piercing injury to the liver or spleen may be hard. You and those close to you may feel scared, sad, or angry. These are normal feelings. Contact the following for more information:

  • American College of Surgeons
    633 N. Saint Clair St.
    Chicago , IL 606113211
    Phone: 1- 312 - 2025000
    Phone: 1- 800 - 6214111
    Web Address:

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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