SURGEONS charged with the care of injured patients have faced an annually increasing number of such patients with major intra-abdominal and intrathoracic injuries.1 The increase is, of course, largely due to a rapid increase in the number of individuals traveling by private vehicle. Among the most perplexing, yet the most fascinating, of these high speed trauma problems is that of the patient with nonpenetrating abdominal trauma. Penetrating wounds, both military and civilian, represent largely a therapeutic challenge; the blunt abdominal injury, on the other hand, is a real diagnostic enigma, testing the acumen of the most experienced clinician on frequent occasion. Further, the magnitude of the damage in nonpenetrating injuries, especially to solid abdominal viscera, is often greater, with a correspondingly higher mortality.
The difficulties in diagnosis and management of nonpenetrating visceral wounds are best illustrated by the problems in blunt hepatic rupture. The not infrequent delay of hours