Abstract
The aim of our study was to examine the possible effect of steatosis and fibrosis on the blunt force vulnerability of human liver tissue. 3.5 × 3.5 × 2-cm-sized liver tissue blocks were removed from 135 cadavers. All specimens underwent microscopical analysis. The tissue samples were put into a test stand, and a metal rod with a square-shaped head was pushed against the capsular surface. The force (Pmax) causing liver rupture was measured and registered with a Mecmesin AFG-500 force gauge. Six groups were formed according to the histological appearance of the liver tissue: intact (group 1), mild steatosis (group 2), moderate steatosis (group 3), severe steatosis (group 4), fibrosis (group 5), and cirrhosis (group 6). The average Pmax value was 34.1 N in intact liver samples (range from 18.1 to 60.8 N, SD ± 8.7), 45.1 N in mild steatosis (range from 24.2 to 79.8 N SD ± 12.6), 55.4 N in moderate steatosis (range from 28.9 to 92.5 N, SD ± 16.0), 57.6 N in severe steatosis (range from 39.8 to 71.5 N, SD ± 11.9), 63.7 N in fibrosis (range from 37.8 to 112.2 N, SD ± 19.5), and 87.1 N in the case of definite cirrhosis (range from 52.7 to 162.7 N, 30.3). The Pmax values were significantly higher in samples with visible structural change than in intact liver sample (p = 0.023, 0.001, 0.009, 0.0001, 0.0001 between group 1 and groups 2 to 6 respectively). Significant difference was found between mild steatosis (group 2) and cirrhosis (group 6) (p = 0.0001), but the difference between mild, moderate, and severe steatosis (groups 2, 3, and 4) was not significant. Our study demonstrated that contrary to what is expected as received wisdom dictates, the diseases of the parenchyma (steatosis and presence of fibrosis) positively correlate with the blunt force resistance of the liver tissue.
Highlights
The liver is the most commonly injured abdominal organ in trauma [1, 2]
Forty-one liver samples showed no microscopic sign of structural change, 33 samples showed mild steatosis, 12 samples showed medium-grade steatosis, 6 samples showed severe steatosis, 11 samples showed fibrosis, and 16 definite cirrhosis
The possible correlation between post-mortem interval (PMI) and Pmax was analysed to assess the possible effect of PMI on blunt force vulnerability of liver tissue
Summary
The liver is the most commonly injured abdominal organ in trauma [1, 2]. Traffic accidents account for the majority of liver injuries [3]. The incidence of traumatic liver injury in total population is 2.95–13.9/100.000 [4, 5]. Thirteen to 16% of polytrauma patients have liver injuries [6]. A direct frontal blunt impact usually causes the injury of the left liver lobe mostly along. Liver injuries can be caused by acceleration, deceleration, and compression/crush/ mechanisms [8]. The minimal impact velocities which can lead to liver injuries are predicted 5–8 m/s [9]. The mechanical vulnerability of tissues can show large individual differences, and these differences influence whether a blunt force results in an injury or not. The possible role of these individual differences has to be assessed in forensic situations many times
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