Cover any open wounds to protect the viscera. The abdominal compartment of anti-shock trousers must NOT be inflated if the patient is pregnant, if there is an open abdominal wound, or if rupture of the diaphragm is suspected. Rupture of the diaphragm is more common than realized. It should be anticipated with any patient with a penetrating wound of the upper abdomen or lower chest. The liver may be lacerated by either blunt or penetrating trauma.
Liver laceration is common.
Biliary tract injury is unusual, and harder to diagnose. Right upper quadrant tenderness will be present. If the patient is stable, a CT scan of the abdomen may demonstrate a laceration that can be managed non-operatively. If the patient is in shock, or has other urgent injuries, perform peritoneal lavage to confirm intraperitoneal hemorrhage. Finding bile on peritoneal lavage means biliary tract injury.