Injury to an Internal Organ: Symptoms and Diagnosis

What to do right away

If you suspect someone has an internal injury:

1. Call 911 or your local emergency number. Internal bleeding cannot be stopped with first aid.
2. Keep them lying still and flat, unless they are vomiting or struggling to breathe, then place them on their side. Do not move them if a spinal injury is possible.
3. Keep them warm with a blanket or coat. Cold worsens bleeding.
4. Give nothing to eat or drink, in case they need surgery.
5. Do not remove an impaled object. Pad around it to keep it still.
6. Press firmly on any visible bleeding with a clean cloth.
7. Watch their breathing and alertness, and start CPR if they stop breathing normally.

Symptoms of internal organ damage

General signs of internal bleeding

Bleeding inside the body is the main danger. Signs that blood loss is significant (hemorrhagic shock) include:

• dizziness or lightheadedness, especially on standing
• fainting or near-fainting
• a fast, weak pulse and fast breathing
• pale, cold, sweaty skin
• extreme thirst
• confusion, restlessness or drowsiness
• passing little urine

Symptoms by organ

Abdominal pain after trauma deserves respect, especially if it is spreading, getting worse or present on coughing and moving. A seat-belt bruise across the belly is a well-known marker of bowel and spine injury.

Why symptoms can be delayed

• A spleen can bleed slowly under its capsule and rupture hours or days later.
• Bowel tears leak contents gradually, so peritonitis (inflammation of the belly lining) and fever may take 12 to 24 hours to appear.
• The body maintains blood pressure until about a third of blood volume is lost, so early bleeding can look like nothing.

Common causes

• Blunt trauma: car and motorcycle crashes, falls, sports collisions, bicycle handlebar injuries, assaults and crush injuries. This causes most internal organ injuries in the US.
• Penetrating trauma: stab wounds and gunshot wounds.
• Blast injuries: pressure waves damage air-filled organs such as the lungs, ears and bowel.
• Medical procedures: rarely, endoscopy, surgery or a biopsy can injure an organ.

People at higher risk of serious bleeding after a minor blow include those taking blood thinners, people with an enlarged spleen (for example from mononucleosis), older adults and people with liver disease.

How doctors detect internal organ damage

Trauma teams follow a set sequence (ATLS): airway, breathing, circulation, neurological status and full exposure, then a detailed examination.

• Vital signs: pulse, blood pressure, breathing rate and oxygen level, checked repeatedly.
• Examination: bruising patterns, tenderness, guarding (tensing of the belly muscles), swelling and breath sounds.
• FAST ultrasound: a quick bedside scan that looks for free blood in the belly, around the heart and in the chest. It takes minutes and can be repeated.
• CT scan with contrast: the main test in a stable patient. It shows which organ is injured and how badly, and whether it is actively bleeding.
• Chest X-ray: for pneumothorax (collapsed lung), hemothorax (blood in the chest) and rib fractures.
• Blood tests: blood count, blood group for transfusion, liver enzymes, amylase or lipase (pancreas), kidney function and lactate.
• Urine test: blood in the urine points to kidney or bladder injury.

Someone who is unstable may go straight to the operating room without a CT.

Treatment

Non-operative management

Many spleen, liver and kidney injuries now heal without surgery. The person is admitted for bed rest, repeated examinations and blood counts, and sometimes a repeat scan. This works best when blood pressure stays stable.

Angioembolization

An interventional radiologist passes a fine catheter through an artery in the groin and blocks the bleeding vessel with coils or particles. This saves many spleens and livers that would once have been removed.

Surgery

Emergency surgery is needed for unstable patients, bowel perforation, most penetrating abdominal wounds and injuries that keep bleeding. Surgeons may repair, partly remove or remove the organ. Removing the spleen (spleen injury) raises the lifelong risk of certain infections, so vaccines are given afterward.

Chest injuries

A chest drain treats a collapsed lung or blood in the chest. Most rib fractures heal with pain control and breathing exercises.

Recovery and complications

Recovery from a managed spleen or liver injury usually means avoiding contact sports and heavy lifting for several weeks to a few months, depending on the grade. Possible complications include delayed bleeding, infection or abscess, bile leak after liver injury, high blood pressure after kidney injury, and adhesions after surgery. Return immediately if pain, dizziness or swelling comes back after discharge.

Prevention

• Wear a seat belt with the lap belt low across the hips, not the belly.
• Use appropriate car seats and booster seats for children.
• Wear protective gear for contact sports, horse riding and motorcycling.
• Avoid contact sports for at least 3 to 4 weeks after mononucleosis, because the spleen may be enlarged.

Frequently asked questions

How do I know if I have internal organ damage?

You cannot be sure without medical tests. Warning signs are worsening belly, chest or back pain, a swollen or rigid belly, shortness of breath, blood in urine or vomit, dizziness, a fast pulse and pale, clammy skin. Any of these after an injury needs emergency care.

How long after an accident can internal injuries show up?

Most show signs within the first few hours, but some take longer. Bowel tears may cause symptoms after 12 to 24 hours, and a spleen can rupture several days later. Seek care at once if new pain, dizziness or swelling develops in the days after an injury.

How do doctors detect internal organ damage?

They examine you and monitor your vital signs, then use a FAST ultrasound to look for internal bleeding and a CT scan with contrast to show which organs are damaged. Blood tests, a urine test and a chest X-ray add more information.

Can internal organ damage heal on its own?

Some can. Many spleen, liver and kidney injuries heal with hospital observation and rest, without surgery. This must be done under close medical monitoring, because bleeding can restart. Injuries to the bowel and most penetrating wounds need surgery.

What does internal bleeding feel like?

It may feel like deep pain or pressure in the belly, chest or back, often with weakness, dizziness, thirst, nausea and a racing heart. Some people notice pain in the shoulder tip. As bleeding continues, the person may become pale, sweaty and confused.

Can you have internal injuries without bruising?

Yes. Serious internal injuries can occur with little or no visible bruising, especially in children, whose ribs bend rather than break. The absence of bruising does not rule out damage to the spleen, liver, bowel or lungs.