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Updated: Jun 2 2021

Visceral Blunt Trauma

Images
https://upload.orthobullets.com/topic/3123/images/rectus sheath hematoma.jpg
https://upload.orthobullets.com/topic/3123/images/liver injury.jpg
https://upload.orthobullets.com/topic/3123/images/renal lac.jpg
https://upload.orthobullets.com/topic/3123/images/hematocoele.jpg
https://upload.orthobullets.com/topic/3123/images/splenomegaly.jpg
  • Introduction
    • Injuries include (specifics below)
      • abdominal wall injuries
      • spleen injuries
      • liver injuries
      • kidney injuries
      • testicular and penile injuries
    • Risk factors
      • contact sports and direct blows are risk factors for visceral injury
      • deceleration pattern of injury is more likely to cause injury to the spleen, liver, or kidney
  • Diaphragmatic Spasm
    • Commonly known as "wind knocked out"
      • caused by a direct blow to epigastrium causing diaphragmatic spasm
    • Treatment
      • observation
        • resolves spontaneously
        • may continue play
  • Abdominal Wall Injury / Rectus Sheath Hematoma
    • Introduction
      • injury to epigastric or intramuscular vessels
    • Presentation
      • acute pain in a localized area is usually a sign of abdominal wall injury
      • symptoms mimic surgical abdomen with nausea and vomiting
      • pain with active trunk flexion or rotation
    • Evaluation
      • diagnosis can be made with CT
    • Treatment
      • nonoperative
        • ice and rest
          • indications
            • most cases
      • operative
        • surgery decompression
          • indications
            • required if persistent progression and pain
  • Spleen Injuries
    • Introduction
      • the most common organ injured in the abdomen as the result of blunt trauma
      • most common cause of death because of an abdominal injury
      • increased risk with splenomegaly after infectious mononucleosis
    • Presentation
      • nausea and vomiting
      • sharp LUQ pain that becomes dull after a time and more diffuse
      • localized pain that progresses to diffuse pain is concerning for visceral injury
    • Evaluation
      • diagnosis can be made with CT
    • Treatment
      • nonoperative
        • clinical observation
          • indicated in most cases
      • operative
        • splenectomy
          • indicated only in severe injuries
  • Liver Injury
    • Introduction
      • the liver is the second most commonly injured organ.
    • Presentation
      • symptoms include right upper quadrant pain that may radiate to right shoulder
    • Evaluation
      • diagnosis can be made with CT
    • Treatment
      • nonoperative
        • conservative treatment with monitoring and rest
  • Kidney Injuries
    • Introduction
      • more common in contact athletes
      • usually occurs with blunt abdominal trauma to flank
    • Presentation
      • look / ask for hematuria
    • Evaluation
      • diagnosis can be made with CT
    • Treatment
      • operative
        • urgent surgery
          • indications
            • extensive bleeding with renal fx or vascular pedicle injury
  • Penile & Testicular Injuries
    • Pudendal nerve neuropraxia
      • introduction
        • common in bicyclists
      • presentation
        • causes penile shaft numbness
      • treatment
        • nonoperative
          • seat modifications
    • Testicular Injury
      • introduction
        • mechanism is usually a kick
        • leads to rupture of tunica albuginea (outer covering)
          • causes a hematocoele
      • presentation
        • painful firm scrotal mass that does not transilluminate
      • diagnosis
        • ultrasound by urology
      • treatment
        • observation
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