Liver and Spleen Injuries and Associated Rib Fractures: An Autopsy Study

The abdominal cavity extends superiorly into the osseocartilaginous thoracic cage to the fourth intercostal space. Consequently, the more superiorly placed abdominal organs (spleen, liver, part of the kidneys, and stomach) are protected by the thoracic cage [1]. It should be appreciated that, from the forensic aspect, the spleen and most of the liver and stomach are thoracic organs in that they lie largely beneath the costal margin, and are vulnerable to both stabbing and blunt injury to the chest [2]. Liver is the largest gland in the body. The anterior surface is triangular and is related to the xiphoid process and the diaphragm on either side. Owing to the size, its fixed position and friable consistency, the liver is frequently wounded by a stab in the abdomen, is often ruptured by a blunt trauma. It may also be lacerated by the fractured ends of the ribs perforating the diaphragm. Spleen lies in the left hypochondriac region of the abdomen, its long axis being parallel to that of 9th rib, behind the stomach and inferior to the diaphragm. On account of its position, rupture of the spleen is rare unless caused by considerable crushing or grinding force. The spleen may sometimes be ruptured by the broken ends of a rib which may be caused by the blunt trauma [3].