Severe blows to the abdomen can hide serious injuries even if there is no visible wound.
Blunt abdominal trauma is one of the most complex and potentially serious surgical emergencies. Although they do not always leave obvious external signs, they can hide severe internal injuries that, if not detected and treated in time, can be life-threatening. Knowing how to identify the warning signs and acting quickly is key.
What is blunt abdominal trauma?
It is defined as any blow, impact or compression to the abdomen without a visible open wound. It is typical in traffic accidents (especially seat belt accidents), falls from heights, sports accidents or assaults.
In contrast to penetrating injuries (with knives or bullets), the damage is caused by deceleration, compression or crushing forceswhich affect internal organs without breaking the skin.
Which organs may be affected?
The most commonly injured are:
- Spleenthe most vulnerable. It can rupture and cause massive internal bleeding.
- Liver: large vascularisation, risk of bleeding.
- Small intestinemay perforate and release digestive contents into the abdomen.
- Kidneysespecially in the case of lateral trauma.
- Pancreas, bladder and great vesselsless frequent, but serious.
What are the symptoms?
Sometimes they can go unnoticed initially. It is therefore vital to observe the patient for hours. Signs of suspicion:
- Persistent or diffuse abdominal pain.
- Hard or distended abdomen ("board belly").
- Nausea, vomiting or dizziness.
- Pallor, cold sweats, tachycardia.
- Hypotension (low blood pressure).
- Shortness of breath or pain referred to the shoulder (sign of diaphragmatic irritation).
⚠️ Important: the absence of visible bruising or wounds does NOT rule out serious internal injury..
How is it diagnosed?
- Physical examination careful.
- Abdominal ultrasound (FAST) in the ER to detect free fluid.
- Computed axial tomography (CAT) scanThe most accurate test for assessing organ damage, active bleeding or collections.
- Blood testshaemoglobin, haematocrit, liver and kidney function.
Treatment: always surgery?
No. Management depends on:
- Haemodynamic stability of the patient.
- Type and severity of injury.
- Response to initial treatment.
🔹 Conservative treatment (without surgery):
- In stable patients with minor injuries (spleen or liver).
- Requires hospitalisation and intensive monitoring.
- Absolute rest, analytical controls and serial studies.
🔹 Emergency surgery:
- In unstable patients or patients with uncontrolled active bleeding.
- In intestinal perforations with peritonitis.
- If the general condition worsens despite conservative treatment.
Surgery may include bleeding control, bowel resection or splenectomy (removal of the spleen).
Possible complications
- Massive internal bleeding.
- Hypovolemic shock.
- Abdominal infection (peritonitis).
- Multi-organ failure if diagnosis is delayed.
- Need for transfusion or intensive care.
Prevention and advice
- Proper use of seat belts (pelvic, not abdominal).
- Avoid unprotected contact sports.
- In accidents with abdominal blows, always go to the Emergency Roomeven without immediate pain.
Blunt abdominal trauma may appear minor but conceal rapidly evolving injuries. Early and thorough assessment, even in the absence of symptoms, can save lives. Clinical judgement and vigilance are essential in deciding whether the patient needs observation, urgent intervention or scheduled surgery.