# Transverse Rupture of Segment II (Couinaud) of the Left Hepatic Lobe in Deceleration Trauma: Morphological Characteristics and a Strategy for Intraoperative Detection

## TL;DR

This study identifies a new type of liver injury in the left hepatic lobe caused by deceleration trauma and suggests a method for detecting it during surgery.

## Contribution

The paper introduces a novel morphological characterization of transverse liver ruptures in segment II caused by ligament traction during deceleration trauma.

## Key findings

- Liver ruptures in segment II of the left lobe were found in 14 cases, near the left coronary and triangular ligaments.
- The incidence of this specific rupture was statistically significant, occurring in 46.2% of analyzed deceleration trauma cases.
- The study proposes a systematic intraoperative inspection method for detecting these ruptures, especially in cases with other ligament-associated injuries.

## Abstract

Background/Objectives: Deceleration can cause liver ruptures via ligament traction, with a specific, little-known transverse rupture in segment II of the left lobe being a concern. This study aimed to provide a detailed morphological characterization of these segment II ruptures, analyse their formation mechanisms using autopsy material, and propose a systematic intraoperative assessment method to improve their detection. Methods: This study analysed the autopsy cases of 132 victims of sudden, violent deceleration (falls from height, traffic accidents) performed between 2011 and 2014. Liver injuries were meticulously described, focusing on the morphological characteristics of ruptures (course, shape, depth) and their location relative to hepatic ligaments. Cases with prior liver resection due to injuries were excluded. Results: Liver ruptures were found in 61 of the 132 analysed cases (46.2%). A “new location” for ruptures was identified on the diaphragmatic surface of the left lobe’s segment II, near and along the left coronary and triangular ligaments. This specific type of rupture was found in 14 cases. Overall, 40 cadavers had liver ruptures near ligaments, totalling 55 such distinct ruptures, indicating that some had multiple ligament-associated tears. The incidence of liver rupture at this newly described site was statistically significant. Conclusions: Transverse rupture of the left hepatic lobe’s segment II, in its subdiaphragmatic area, results from ligament “pulling” forces during deceleration and is a characteristic injury. Its presence should be considered following blunt abdominal trauma involving deceleration, and the subdiaphragmatic area of the left lateral lobe requires intraoperative inspection, especially if other ligament-associated liver ruptures are found.