[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Blunt abdominal trauma

[Conditions](https://durgical.com/en/conditions/) · [Surgery and trauma](https://durgical.com/en/conditions/)

# 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](https://durgical.com/en/anatomy/spleen/) or bowel and cause hidden bleeding.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Liver](https://durgical.com/en/anatomy/liver/)
- [Spleen](https://durgical.com/en/anatomy/spleen/)
- [Kidneys](https://durgical.com/en/anatomy/kidney/)
- [Peritoneum](https://durgical.com/en/anatomy/peritoneum/)
- [Pancreas](https://durgical.com/en/anatomy/pancreas/)
- [Duodenum](https://durgical.com/en/anatomy/duodenum/)
- [Jejunum](https://durgical.com/en/anatomy/jejunum/)
- [Diaphragm](https://durgical.com/en/anatomy/diaphragm/)
- [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/)
- [Ribs (back part)](https://durgical.com/en/anatomy/ribs/)
- [Rectus abdominis](https://durgical.com/en/anatomy/rectus-abdominis-muscle/)
- [Splenic artery](https://durgical.com/en/anatomy/splenic-artery/)
- [L1 vertebra](https://durgical.com/en/anatomy/lumbar-vertebra/)

## Why it happens

- [Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does](https://durgical.com/en/general-pathology/hemorrhage-petechiae-purpura-ecchymosis-hematoma-and-what-blood-loss-does/)
- [Mechanical and electrical injury: abrasion, contusion, laceration, wounds](https://durgical.com/en/general-pathology/mechanical-and-electrical-injury-abrasion-contusion-laceration-wounds/)
- [Shock physiology](https://durgical.com/en/physiology/shock-physiology/)

## What it is

Injury to the [abdomen](https://durgical.com/en/anatomy/region/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](https://durgical.com/en/anatomy/pancreas/), [kidneys](https://durgical.com/en/anatomy/kidney/) 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](https://durgical.com/en/anatomy/region/spine/) or [ribs](https://durgical.com/en/anatomy/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](https://durgical.com/en/anatomy/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](https://durgical.com/en/anatomy/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

## Red flags

- Haemodynamic instability with a positive FAST
- Peritonitis
- Seatbelt sign, especially with a lumbar spine (Chance) fracture: high risk of bowel and mesenteric injury
- Falling haemoglobin or ongoing transfusion during observation
- Distended tense abdomen with rising airway pressures or falling urine output (abdominal compartment syndrome)

## Diagnosis

**Clinical**
ATLS primary survey, then repeated abdominal examination; the examination is unreliable in patients with head injury, intoxication or [spinal cord](https://durgical.com/en/anatomy/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](https://durgical.com/en/anatomy/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](https://durgical.com/en/anatomy/region/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.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/blunt-abdominal-trauma/)

## Related conditions

- [Splenic injury](https://durgical.com/en/conditions/splenic-injury/)
- [Major trauma (polytrauma): ATLS primary survey](https://durgical.com/en/conditions/major-trauma-atls-primary-survey/)
- [Pelvic fracture](https://durgical.com/en/conditions/pelvic-fracture/)
- [Peritonitis](https://durgical.com/en/conditions/peritonitis/)
- [Hypovolaemic shock](https://durgical.com/en/conditions/hypovolaemic-shock/)
- [Rib fractures](https://durgical.com/en/conditions/rib-fractures/)
- [Penetrating trauma (stab and gunshot wounds)](https://durgical.com/en/conditions/penetrating-trauma/)

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

Sources: [Liver trauma: WSES 2020 guidelines](https://pmc.ncbi.nlm.nih.gov/articles/PMC7106618/) (World Journal of Emergency Surgery, 2020); [Splenic trauma: WSES classification and guidelines for adult and pediatric patients](https://pmc.ncbi.nlm.nih.gov/articles/PMC5562999/) (World Journal of Emergency Surgery, 2017).

[← All conditions](https://durgical.com/en/conditions/)

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/conditions/blunt-abdominal-trauma/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/blunt-abdominal-trauma/