Blunt abdominal trauma !

Blunt abdominal trauma is a hit to the belly without an open wound, as in car crashes. It can tear the liver, spleen or bowel and cause hidden bleeding.

Updated 2026-11-01

Structures involved

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Why it happens

What it is

Injury to the abdomen from impact, compression or deceleration without penetration of the abdominal wall. The spleen and liver are the organs most often injured; bowel, mesentery, pancreas, kidneys and bladder can also be damaged.

Who gets it

Road traffic crashes, especially motorcycle crashes, are the main cause in Colombia and Latin America, followed by falls and assaults. Solid-organ injuries are frequent in polytrauma, and most stable patients today are treated without surgery.

Causes

Road traffic crashes (motorcycle, car, pedestrian struck)
Falls from height
Assaults and kicks
Handlebar and sports injuries
Crush injuries

Risk factors

Not wearing a seatbelt, or a lap-only belt (seatbelt syndrome)
High-speed or high-energy mechanism
Lower rib fractures (spleen and liver injury)
Children, whose organs are less protected by the rib cage
Anticoagulant use

Pathophysiology

Direct compression crushes solid organs against the spine or ribs, deceleration shears organs at their fixed attachments (mesentery, renal pedicle) and a sudden rise in intraluminal pressure can burst hollow viscera. Solid organs bleed, often into the peritoneum; hollow organs leak content and cause peritonitis that may appear hours later.

Classification

Solid-organ injury (spleen, liver, kidney) graded by AAST scales from I to V
WSES classes combine anatomy with haemodynamic status (minor, moderate, severe)
Hollow-viscus and mesenteric injury
Retroperitoneal injury: duodenum, pancreas, kidneys, major vessels

Symptoms and signs

Abdominal pain and tenderness, which may be mild at first
Bruising of the abdominal wall, including a seatbelt sign
Left shoulder tip pain from splenic bleeding (Kehr sign)
Distension, guarding and rigidity
Signs of shock: tachycardia, pallor, hypotension
Blood in the urine after kidney or bladder injury

Diagnosis

Clinical: ATLS primary survey, then repeated abdominal examination; the examination is unreliable in patients with head injury, intoxication or spinal cord injury. Haemodynamic status, not the injury grade, decides the next step.
Tests: Haemoglobin repeated over time, blood group and crossmatch, lactate and base deficit, amylase and lipase (pancreatic injury), liver enzymes, urinalysis for blood, and a pregnancy test in women.
Imaging: FAST at the bedside detects free fluid in unstable patients but can miss bowel and retroperitoneal injuries. Contrast-enhanced CT is the reference standard in stable patients and guides nonoperative management; it shows active contrast blush.

Differential diagnosis

Abdominal wall contusion only
Retroperitoneal haematoma from a pelvic or spinal fracture
Bleeding into the chest (haemothorax) as the source of shock
Lower rib fractures causing upper abdominal pain

Goal of treatment

Stop the bleeding, preserve organs (especially the spleen) when safe, detect hollow-organ injury early, and avoid unnecessary laparotomy in stable patients.

Treatment

Acute: ATLS resuscitation with early blood products and bleeding control; unstable patients with a positive FAST go to the operating room.
Surgical: Laparotomy for instability, peritonitis or hollow-viscus injury: haemorrhage control, splenectomy or splenorrhaphy, liver packing, and damage control with temporary abdominal closure when needed.
Conservative: Nonoperative management of solid-organ injuries in haemodynamically stable patients without peritonitis, in centres with continuous monitoring and rapid access to surgery.
Procedure: Angioembolisation when CT shows active arterial bleeding (contrast blush) in a stable or stabilised patient.
Follow-up: Nursing priorities: frequent vital signs, serial abdominal examination and haemoglobin, bed rest initially, urine output, and early warning of deterioration; vaccination against encapsulated bacteria after splenectomy.

Complications

Haemorrhagic shock
Delayed splenic rupture
Peritonitis and sepsis from missed bowel injury
Bile leak, biloma and liver abscess
Pancreatic fistula or pseudocyst
Abdominal compartment syndrome
Overwhelming post-splenectomy infection

Prognosis

Most stable patients with solid-organ injuries recover without surgery. Mortality is driven by associated injuries, especially brain injury, and by delayed recognition of bleeding or bowel perforation.

Prevention

Seatbelts with shoulder straps and appropriate child restraints
Motorcycle safety measures and speed control
Fall prevention

Test yourself

Think of the answer, then tap the question to see it.

Which solid organ is most often injured in blunt abdominal trauma?

The spleen, followed closely by the liver.

What is the next step for a hypotensive blunt trauma patient with free fluid on FAST?

Emergency laparotomy (with resuscitation); unstable patients do not go to the CT scanner.

What does a seatbelt sign suggest?

A higher risk of hollow-viscus and mesenteric injury and of a lumbar flexion-distraction (Chance) fracture.

What is the imaging study of choice in a haemodynamically stable patient with blunt abdominal trauma?

Contrast-enhanced CT of the abdomen and pelvis.

Which vaccinations are needed after a splenectomy?

Vaccines against encapsulated bacteria: pneumococcus, meningococcus and Haemophilus influenzae type b.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Liver trauma: WSES 2020 guidelines (World Journal of Emergency Surgery, 2020); Splenic trauma: WSES classification and guidelines for adult and pediatric patients (World Journal of Emergency Surgery, 2017).

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Representative model, for educational purposes only.

Liver highlighted on the Durgical 3D model