Spontaneous rupture of the liver.

Four cases of spontaneous rupture of the liver are reported. In all these cases, pathological processes in the liver caused the rupture, i.e. primary hepatoma in 3 cases and a benign angiomatous tumour in one case. In one case, the diagnosis was not established until autopsy and in 3 cases at operation. In one of these latter cases, however, the bleeding source was not found until at a secondary surgical exploration. In none of the patients was the diagnosis suspected preoperatively. Four-quadrant puncture is highly recommended even in patients with only a slight suspicion of intra-abdominal hemorrhage. In cases with a ruptured solitary primary liver tumour, an acute liver resection might be performed. If there are multiple tumours--primary or secondary--simple hemostasis seems to be the treatment of choice. In patients with intra-abdominal hemorrhage, thorough palpation of the whole liver is an obligatory manovre during surgery.