Q&A: Diagnosis Of Sports-related Blunt Abdominal Injury

Blunt abdominal trauma is regularly encountered in the emergency department (ED). The lack of historical data and the presence of distracting injuries or altered mental status, from head injury or intoxication, can make these injuries difficult to diagnose and manage. Victims of blunt trauma often have both abdominal and extra-abdominal injuries, further complicating care.

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In this article:
Epidemiology of blunt abdominal trauma
MCQ: clinical scenario
MCQ: answer
MCQ: explanation

Epidemiology of blunt abdominal trauma

Blunt abdominal trauma (BAT) accounts for the majority (80 percent) of abdominal injuries seen in the Emergency Department, and is responsible for substantial morbidity and mortality. The majority of BAT cases (75 percent) are related to motor vehicle collision (MVC) or auto versus pedestrian accidents. Blows to the abdomen and falls are responsible for 15 and 6 to 9 percent, respectively. Occult BAT may occur with child abuse and domestic violence.

The prevalence of intra-abdominal injury among patients presenting to the emergency department with BAT is approximately 13 percent. The spleen and liver are the most commonly injured solid organs in BAT. Injuries to the pancreas, bowel and mesentery, bladder, and diaphragm, as well as retroperitoneal structures (kidneys, abdominal aorta), are less common but must also be considered.

MCQ: clinical scenario

Following an American football training session, a player experienced an acute left flank pain that lasted 4 to 5 hours and was accompanied by macroscopic hematuria and marked tenderness in the left costovertebral angle. A large mass was palpable in the left loin. Investigation demonstrated proteinuria and a rapid deterioration in renal function. An intravenous pyelogram was obtained, and it showed marked enlargement of the left kidney with poor visualization of pelvicalyceal system.

The most likely diagnosis is:

a) Polycystic disease of the kidneys
b) Berger's nephritis
c) Systemic lupus erythematosus
d) Renal vein thrombosis
e) Goodpasture's syndrome

MCQ: answer

The correct answer is D

MCQ: explanation

Renal vein thrombosis secondary to trauma is usually accompanied by renal artery thrombosis. The history of the trauma, the severe acute flank pain, and a palpable mass are usually suggestive of this condition.

Reference(s)
1). UpToDate: Initial evaluation and management of blunt abdominal trauma in adults. Available online: https://www.uptodate.com/contents/initial-evaluation-and-management-of-blunt-abdominal-trauma-in-adults