Abdominal trauma

Abdominal trauma is a leading contributor to preventable trauma death: post-traumatic bleeding and traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not recognised and treated promptly.^[1] The abdomen holds multiple organs, physical signs are often subtle, and bedside imaging is imperfect — so the emergency physician's task divides into three problems: identify intra-abdominal bleeding in the unstable patient (FAST, then theatre), characterise the organ injury in the stable patient (contrast CT), and maintain a high index of suspicion for the hollow viscus and pancreatic injuries that imaging may miss in the first hours.^[9]

Blunt and penetrating abdominal trauma

Abdominal trauma is divided by mechanism, and the mechanism predicts which organs are injured. Blunt trauma — the motor-vehicle collision, fall, assault, bicycle handlebar — transfers energy across the abdominal wall and produces solid-organ injury (spleen, liver, kidney) and, with a seat-belt force, the hollow viscus and mesenteric injury. Penetrating trauma — the stab, gunshot, shotgun — injures along the track, with hollow viscus and major vascular structures predominant. The examination assesses distension, tenderness, guarding, rigidity and bruising (the seat-belt sign, flank and periumbilical ecchymosis), but examination alone is unreliable and imaging is essential.^[1]

References19ShowHide

1. [1]Rossaint R, Afshari A, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition Crit Care, 2023.PMID 36859355
2. [2]Granieri S, et al. Blunt traumatic hollow viscus and mesenteric injuries: a comparison of the currently available scoring systems Eur J Trauma Emerg Surg, 2026.PMID 41801452
3. [3]Özcan Sıkı F, Sarıkaya M, Yağmurlu İ, et al. Treat the patient, not the grade of injury: modern management of solid organ trauma in children BMC Surg, 2026.PMID 42249394
4. [4]Dhillon NK, et al. When blood runs thin: A national analysis of failure of nonoperative management of high-grade splenic injuries in patients on pre-injury anticoagulant or antiplatelet therapy J Trauma Acute Care Surg, 2026.PMID 41925620
5. [5]Roh S. Splenic artery embolization for trauma: a narrative review J Trauma Inj, 2024.PMID 39736501
6. [6]Dionne B, Dehority W, Brett M, et al. The Asplenic Patient: Post-Insult Immunocompetence, Infection, and Vaccination Surg Infect (Larchmt), 2017.PMID 28498097
7. [7]Chung CY, Scalea TM. Damage control surgery: old concepts and new indications Curr Opin Crit Care, 2023.PMID 37861194
8. [8]Coccolini F, Kobayashi L, Kluger Y, et al. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines World J Emerg Surg, 2019.PMID 31867050
9. [9]Smyth L, Bendinelli C, Lee N, et al. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment World J Emerg Surg, 2022.PMID 35246190
10. [10]Savoia P, Jayanthi SK, Chammas MC. Focused Assessment with Sonography for Trauma (FAST) J Med Ultrasound, 2023.PMID 37576415
11. [11]Bartzak S. Identification of Delayed Traumatic Diaphragmatic Injury: A Concise Review J Trauma Nurs, 2022.PMID 35007251
12. [12]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial Lancet, 2010.PMID 20554319
13. [13]Roberts I, Shakur H, Afolabi A, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial Lancet, 2011.PMID 21439633
14. [14]Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial JAMA, 2015.PMID 25647203
15. [15]Stassen NA, Bhullar I, Cheng JD, et al. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline J Trauma Acute Care Surg, 2012.PMID 23114484
16. [16]Coccolini F, Montori G, Catena F, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients World J Emerg Surg, 2017.PMID 28828034
17. [17]Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome Intensive Care Med, 2013.PMID 23673399
18. [18]Serag I, et al. A meta-analysis of the incidence of intra-abdominal injuries associated with thoracic or lumbar flexion-distraction injuries Injury, 2025.PMID 40273660
19. [19]O'Donnell J, McGreal G, Daly P, et al. Management of patients undergoing splenectomy in an Irish teaching hospital: impact of guidelines Ir J Med Sci, 2004.PMID 15693382