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Blunt Abdominal Trauma in Sports

Adam, Jessalynn MD; De Luigi, Arthur Jason DO

Current Sports Medicine Reports: October 2018 - Volume 17 - Issue 10 - p 317–319
doi: 10.1249/JSR.0000000000000519
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Department of Physical Medicine and Rehabilitation, MedStar Georgetown University Hospital/National Rehabilitation Hospital, Washington DC

Address for correspondence: Jessalynn Adam, MD, Department of Physical Medicine and Rehabilitation, MedStar Georgetown University Hospital/National Rehabilitation Hospital, 37th and O Streets, N.W., Washington D.C. 20057; E-mail: jessalynn.adam@gmail.com. Column Editor: Nailah Coleman, MD, FAAP, FACSM; E-mail: ncoleman@childrensnational.org.

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Background

Injuries to the abdomen are rare, but most commonly occur in collision or contact sports. Sideline management of abdominal trauma is challenging, as even minor traumas may result in potentially life-threatening abdominal injuries. Splenic injuries account for 25% of blunt abdominal traumas. While liver injuries account for 15% to 20% of blunt abdominal traumas, they represent 50% of deaths due to blunt abdominal trauma (1).

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Pathophysiology

Most sport-related abdominal injuries result from high- or low-energy blunt trauma, due to collision or impact from a projectile. Various sports allow or utilize protective equipment that offers some protection from direct contact to the abdomen; however, the majority of athletes across all sports do not use any abdominal protective equipment.

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Risk Factors

Contact sports have a higher risk of abdominal trauma than noncontact sports. Any athlete with a condition that increases the size of the spleen or liver is at higher risk of injury to these structures, should he or she sustain blunt trauma to the abdomen.

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Initial Sideline Management

Initial evaluation should focus on ascertaining the mechanism and severity of the injury. Direct blows more commonly cause injury to the abdominal wall, while deceleration injuries typically affect viscera (2). The athlete should be closely monitored for signs of shock, hemoperitoneum, or acute abdomen, such as percussion tenderness, guarding, or pain with activity. Maintain a high suspicion for intra-abdominal injuries. Athletes with suspected abdominal trauma should remain supine and be transferred by ambulance.

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Imaging

Imaging for abdominal trauma varies, depending on injury severity, but may include radiography (XR), Focused Assessment for Trauma Ultrasound (FAST US), computed tomography (CT), and/or magnetic resonance imaging (MRI) (see the Table).

Table

Table

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Treatment and Return to Play

Rest and ice are sufficient for most musculoskeletal abdominal injuries. Intra-abdominal injuries may require surgery, particularly for more severe traumas involving the liver, kidney, or spleen. Time to return to play varies depending on the extent of the injury (Table).

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Conclusions

Abdominal injuries are rare in sports but can have a subtle presentation and be catastrophic. Abdominal wall injuries can be managed conservatively and resolve quickly; however, suspected visceral or intra-abdominal injury warrants transfer to the emergency department for further evaluation (2).

The authors declare no conflict of interest and do not have any financial disclosures.

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References

1. Rao A. Sports gastroenterology and abdominal injuries and conditions. In: Harrast MA, Finnoff JT, editors. Sports Medicine: Study Guide and Review for Boards. 2nd ed. New York (NY): Demos Medical Publishing; 2017. p. 411–3.
2. Rifat SF, Gilvydis RP. Blunt abdominal trauma in sports. Curr. Sports Med. Rep. 2003; 2:93–7.
3. Gannon EH, Howard T. Splenic injuries in athletes: a review. Curr. Sports Med. Rep. 2010; 9:111–4.
4. Rolison CJ, Mitchell JL, Smoot MK. Sports nephrology and urology. In: Harrast M, Finnoff JT, editors. Sports Medicine: Study Guide and Review for Boards. 2nd ed. New York (NY): Demos Medical Publishing; 2017. p. 426–8.
    Copyright © 2018 by the American College of Sports Medicine.