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).
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.
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.
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.
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).
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).
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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