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Blunt abdominal trauma refers to non-penetrating injury to the abdomen caused by external mechanical forces (e.g., road traffic accidents, falls, assaults, sports injuries).

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It can damage both solid organs (liver, spleen, kidneys, pancreas) and hollow viscera (stomach, bowel, bladder), often with significant morbidity and mortality.

Etiopathology

Mechanism of Injury

• Motor vehicle accidents (most common): direct impact from steering wheel, seat belt, or deceleration injury.
• Falls from height.
• Assault / crush injuries.
• Sports-related injuries (e.g., cricket, football, boxing).

Pathophysiology of injury mechanisms:

• Direct compression: causes laceration, contusion, or rupture of solid organs.
• Deceleration / shearing forces: tearing at fixed attachment points (e.g., splenic hilum, mesenteric root, renal pedicle).
• Sudden increase in intraluminal pressure: rupture of hollow viscus.

![Frequent trauma sites and complications: Frequent injury patterns in patients with trauma include traumatic brain injury, thorax trauma, soft tissue injury, fractures, abdominal trauma and spinal cord injury. Soft tissue injury is often underestimated clinically, although it contributes to systemic inflammation through the accumulation of tissue debris and damage-associated molecular patterns, as well as bleeding; trauma-induced haemorrhage leads to shock. Major complications of trauma include loss of consciousness, hypoxia, external and internal tissue damage, localized and systemic infection, as well as pain, stress and mental disorders. Hypothermia, acidosis and coagulopathy — known as the lethal triad — are highly predictive of unfavourable patient outcomes, especially during the first 24 h after trauma. Bleeding with the development of shock remains the principal cause of early death. Late trauma-caused lethality is mainly due to traumatic brain injury and multi-organ dysfunction, including trauma-associated acute kidney injury. IRI, ischaemia–reperfusion injury.

Messerer, D.A.C., Halbgebauer, R., Nilsson, B. et al. Immunopathophysiology of trauma-related acute kidney injury. Nat Rev Nephrol 17, 91–111 (2021). https://doi.org/10.1038/s41581-020-00344-9](attachment:69278d0a-5e26-4e50-8426-906ad69681d3:41581_2020_344_Fig1_HTML.webp)

Frequent trauma sites and complications: Frequent injury patterns in patients with trauma include traumatic brain injury, thorax trauma, soft tissue injury, fractures, abdominal trauma and spinal cord injury. Soft tissue injury is often underestimated clinically, although it contributes to systemic inflammation through the accumulation of tissue debris and damage-associated molecular patterns, as well as bleeding; trauma-induced haemorrhage leads to shock. Major complications of trauma include loss of consciousness, hypoxia, external and internal tissue damage, localized and systemic infection, as well as pain, stress and mental disorders. Hypothermia, acidosis and coagulopathy — known as the lethal triad — are highly predictive of unfavourable patient outcomes, especially during the first 24 h after trauma. Bleeding with the development of shock remains the principal cause of early death. Late trauma-caused lethality is mainly due to traumatic brain injury and multi-organ dysfunction, including trauma-associated acute kidney injury. IRI, ischaemia–reperfusion injury.

Messerer, D.A.C., Halbgebauer, R., Nilsson, B. et al. Immunopathophysiology of trauma-related acute kidney injury. Nat Rev Nephrol 17, 91–111 (2021). https://doi.org/10.1038/s41581-020-00344-9

Clinical Presentation

• Abdominal pain, tenderness, guarding, distension.
• Signs of peritonitis (if hollow viscus rupture).
• Hypotension, tachycardia, shock (internal hemorrhage).