Durgical
EN
Open the app

Abdominal and pelvic injuries

  • Finding

Blows to the abdomen can tear the liver, spleen or bowel with almost no mark on the skin; the bleeding can take hours to kill.

Updated

What it is

The abdominal wall is soft and absorbs energy, so a blow, kick or stamp can tear the organs inside while the skin shows little. The liver is the organ most often injured in fatal blunt abdominal trauma, followed by the spleen and the kidneys. The bowel and mesentery tear when they are crushed against the spine, typical of kicks, stamps and handlebar or seat-belt injuries. A patterned bruise or abrasion on the abdominal wall means the force was enough to injure the organs below. Pelvic fractures bleed heavily and accompany traffic collisions and falls. Deaths may be delayed: slow bleeding, peritonitis from a torn bowel, or pancreatic injury. In children, a bowel or pancreatic injury without a major accident raises concern for abuse.

How to tell it apart

  • Resuscitation can tear the liver or spleen; the history and the amount of bleeding help separate it from a blow.
  • A diseased liver or spleen (fatty, cirrhotic, enlarged by infection) changes its vulnerability; the injury still needs a cause.
  • Delayed splenic rupture can occur days after the injury: the medical record links it to the event.
  • Bowel injury in a child is rarely accidental without a clear high-energy event.

How to recognise it

  • Liver and spleen: capsular tears, deep lacerations, subcapsular haematoma.
  • Bowel and mesentery: bruising, tears, perforation, bleeding into the mesentery.
  • Kidneys and retroperitoneum: haematoma behind the peritoneum.
  • Pelvis: ring fractures with large retroperitoneal bleeding; bladder and urethral tears.

How it forms

  • Direct blow: the organ is crushed between the force and the spine or ribs.
  • Deceleration: mobile organs pull on their attachments (liver ligaments, spleen pedicle, mesentery).
  • Raised pressure: sudden squeezing can burst a hollow organ.
  • Delayed death: slow bleeding, delayed rupture of a subcapsular haematoma of the spleen, peritonitis, sepsis.

Step by step

  1. Measure the blood in the abdomen and in the retroperitoneum.
  2. Examine each organ and the mesentery; record the size, depth and site of each tear.
  3. Examine the abdominal wall layer by layer to show deep bruising under normal skin.
  4. Take histology of tears and haematomas to estimate their age.

Next step: what to do and document

  • Document any mark on the abdominal wall even if small: site, shape, size and any pattern, with a photograph and scale if possible.
  • Record the time of injury, vital signs and the course; a delayed deterioration links the later finding to the event.
  • Keep the operative notes in detail: which organ, which tear, how much blood, what was repaired or removed.
  • Preserve removed organs or tissue as the protocol requires, with chain of custody if the case may be judicial.
  • In a child with an abdominal injury and an unclear story, follow the child-protection reporting route.

Common mistakes

  • Excluding serious injury because the skin of the abdomen is normal.
  • Not recording the patterned mark that explains the mechanism.
  • Missing a delayed splenic rupture or a slow bowel leak in an injured patient who seems well.
  • Calling liver tears from resuscitation the result of a blow without checking the record.

Test yourself

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

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

The liver, followed by the spleen and the kidneys.

Why can kicks or stamps tear the bowel or pancreas?

Because the force crushes them against the spine, often with little mark on the abdominal skin.

What does a patterned abdominal-wall abrasion from a handlebar suggest?

That the force was enough to injure the organs below; internal injury should be looked for even if the patient seems well.

Add to my cards (3)

Elsewhere in DurgiPedia

Connections

← All of forensic medicine

Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.

Sources: Blunt Abdominal Trauma (StatPearls Publishing (NCBI Bookshelf), 2023); Assessment of Frequency, Patterns, and Causes of Blunt Abdominal Trauma in a North Indian Cohort: An Autopsy-Based Study (Cureus (PMC), 2023); Liver Trauma (StatPearls Publishing (NCBI Bookshelf), 2026); Splenic Trauma (StatPearls Publishing (NCBI Bookshelf), 2025); Patterned abdominal wall bruise: An indicator of severe intra-abdominal injury (Journal of Indian Association of Pediatric Surgeons (PMC), 2021).

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.