Liver rupture caused by isolated blunt force impact: the result of a blow, a kick or a fall?

A total of 5534 protocols of judicial and extrajudicial autopsies performed at the Institute of Legal Medicine of the University of Würzburg between 1974 and 1987 were examined to determine whether an isolated liver rupture can be attributed to a blow, a kick or a fall on a level plane or against a hard edge, based on the nature of the injury alone. From the 5534 autopsies examined, 293 cases of falling on level ground or down staircases were found. In 271 cases the abdomen struck against a flat surface, in 21 cases either against a post or an edge and in one case it was not possible to find out which object the abdomen struck against. A liver rupture was found in only four cases. It is highly unlikely that liver rupture will be caused by a fall on a level plane or down steps. This empirical finding is further supported by biomechanical calculations. A fall on a level plane can only cause a liver rupture if the abdomen strikes against a hard edge or a stake-like object. If such an event can be excluded, the most likely cause of the liver rupture is a blow or a kick. In all cases of liver rupture, however, the differential diagnosis must exclude extrathoracic heart massage as the cause.