Injury to the Abdomen (Abdominal Trauma)

What to do right away

1. Call 911 or your local emergency number for any penetrating wound, high-speed crash, or worsening pain.
2. Keep the person lying still and warm. Do not give food or drink, in case surgery is needed.
3. Press firmly on bleeding wounds with a clean cloth.
4. Leave impaled objects in place. Pad around them to stop movement.
5. Cover protruding bowel with a clean, moist cloth or plastic wrap. Do not push it back in.
6. Watch for shock: pale, cold, sweaty skin, confusion and a fast, weak pulse. Raise the legs if there is no spinal injury suspected.

Abdominal injury meaning

In medical terms, abdominal trauma means injury to the area between the chest and pelvis, including the flanks and lower back, where the kidneys sit. Doctors split it into two kinds:

Our abdominal trauma page covers the trauma-team view in more detail.

Blunt abdominal injury symptoms

Symptoms can be mild at first and build over hours as blood or bowel contents collect.

• Abdominal pain that worsens rather than settles, or sharp abdominal pain on moving or coughing
• Tenderness, guarding or rigidity: the belly muscles tighten over an injured organ
• Bruising, especially a seat belt mark across the lower belly or around the navel, or bruising in the flanks
• Swelling of the belly
• Nausea and vomiting, sometimes with blood
• Left shoulder tip pain (Kehr's sign) from blood irritating the diaphragm, a classic sign of spleen injury
• Blood in the urine from kidney or bladder injury
• Signs of blood loss: dizziness, thirst, pale skin, rapid heartbeat, fainting

People who are drunk, have a head injury, or have other painful injuries may not feel or report belly pain. That is why trauma teams scan anyone with a dangerous mechanism of injury.

Organs commonly injured

• Spleen: the organ most often injured in blunt trauma. It bleeds heavily. See spleen injury.
• Liver: large and fixed in place, so it tears in deceleration injuries. See liver injury.
• Kidneys: injured by blows to the back or flank, often with blood in the urine.
• Bowel and mesentery: crushed against the spine by seat belts or handlebars. Injury can show up late as peritonitis, with fever and worsening pain over 12 to 48 hours.
• Pancreas: injured by a direct upper-belly blow such as a handlebar. Symptoms can be delayed for days.
• Diaphragm: can tear, letting organs move into the chest.
• Bladder: especially if it is full at the time of injury or the pelvis is broken.

How doctors diagnose abdominal injuries

1. Primary survey: airway, breathing, circulation and control of bleeding come first.
2. Examination: of the whole belly, back, flanks, chest and pelvis, including looking for seat belt signs.
3. FAST ultrasound: a quick bedside scan for free blood around the liver, spleen, pelvis and heart.
4. CT scan with contrast: the main test in stable patients. It shows organ tears, active bleeding and free air from bowel injury.
5. Blood and urine tests: blood count, liver and pancreatic enzymes, blood type, and urine for blood. Pregnancy test in women of childbearing age.
6. Observation and repeat exams: a normal first CT does not always exclude bowel injury, so people are often re-examined over 12 to 24 hours.

Treatment

• Nonoperative management: most stable spleen, liver and kidney injuries now heal without surgery. You will be watched in the hospital with bed rest, repeat blood counts and scans.
• Angioembolization: an interventional radiologist blocks the bleeding vessel through a catheter passed from the groin.
• Surgery (laparotomy): for unstable patients with internal bleeding, bowel perforation, most gunshot wounds, and peritonitis. Damaged sections of bowel are repaired or removed, and the spleen may be removed.
• Blood transfusion and fluids for blood loss.
• Antibiotics when the bowel is injured.

People who lose their spleen need vaccines against pneumococcus, meningococcus and Haemophilus influenzae type b, because they are more vulnerable to these infections for life.

Complications

• hemorrhagic shock from uncontrolled bleeding
• delayed rupture of the spleen days after the injury
• peritonitis, abscess and sepsis from bowel injury
• pancreatic fistula or pseudocyst
• bowel perforation discovered late
• abdominal compartment syndrome, where swelling raises pressure inside the belly

Recovery and returning to activity

After nonoperative care of a spleen or liver injury, most people avoid contact sports and heavy lifting for about 6 to 12 weeks, depending on the grade of injury. Return to normal activity after surgery takes 4 to 8 weeks or more. Seek help at once for new or worsening pain, dizziness or fever during recovery.

Frequently asked questions

What are the symptoms of a blunt abdominal injury?

Common symptoms are belly pain that worsens, tenderness or a rigid belly, bruising (especially from a seat belt), nausea or vomiting, blood in the urine, and left shoulder pain. Dizziness, a racing heart and pale, sweaty skin suggest internal bleeding and need 911.

What does abdominal injury mean?

It means damage to the abdominal wall or to the organs inside the belly, such as the spleen, liver, bowel or kidneys. It is divided into blunt injuries, from blows and crashes, and penetrating injuries, from stab or gunshot wounds.

Can internal bleeding in the abdomen be delayed?

Yes. Bleeding can be slow at first and become obvious hours later, and a damaged spleen can occasionally rupture days after the injury. Bowel injuries may cause peritonitis 12 to 48 hours later. Get re-checked for any new or worsening pain.

How do I know if a stomach injury after a fall is serious?

Warning signs are pain that keeps getting worse, a hard or swollen belly, vomiting, blood in urine or stool, shoulder tip pain, dizziness or fainting. A minor bruise that is improving, with normal eating and no other symptoms, is less worrying. When in doubt, get seen.

What is a seat belt sign?

A seat belt sign is a band of bruising across the lower belly or chest after a crash. It signals that a lot of force went through the belt, and it is linked to a higher risk of bowel, mesentery and lower-spine injuries. Anyone with it should have a CT scan.