Abdominal Injuries in Sports - Types, Causes, Diagnosis, and Treatment

Introduction

Even minor abdominal injuries, ranging in severity from abdominal strains to internal bleeding, can be excruciatingly painful in athletes. Therefore, sports physical therapists must be knowledgeable about stomach injuries. To properly treat the athlete and determine whether "proper treatment" entails keeping them out of the game or transporting them to emergency care, the medical professional treating the athlete in the stadium or arena must be aware of the signs and symptoms, potential risks, as well as the mechanism of injury for many of these common injuries. It is crucial to understand abdominal injuries because they have the potential to be among the most harmful for athletes.

What Are the Types of Abdominal Injuries?

Musculoskeletal and intra-abdominal visceral injury are the two types of abdominal injury.

• Musculoskeletal Injury: The injury is further classified into

  • Muscular Contusion: A blunt trauma to the abdominal wall caused by sports or collisions. It is characterized by tenderness, swelling, and bruising and often recovers on its own with adequate rest.

  • Rectus Sheath Hematomas: The rupture of the epigastric vein or artery leads to hematoma of the rectus muscle (abdominal muscles responsible for six-packs). Surgery is indicated based on severity.

• Intra-abdominal Visceral Injury: The injury is further classified into

  • Splenic Injury: The spleen is not fully covered in children; hence, the direct blow to the abdomen results in the displacement of the left low rib followed by a fracture. It is characterized by the Cullen sign (superficial edema and bruising under the umbilical region), and splenectomy (spleen removal) is indicated based on severity.

  • Hepatic Injury: The liver is more vulnerable to injury in abdominal trauma. The direct blow to the abdomen results in liver enlargement, hepatomegaly, and hepatitis. It is characterized by nausea, vomiting, and hemodynamic instability. The treatment involves laparotomy and DPL (diagnostic peritoneal lavage).

  • Renal Injury: The most common in children is due to trauma to the flank. Which is distinguished by ecchymosis and hematuria. Surgery is based on the worsening of the symptoms.

What Is the Cause of an Abdominal Injury?

The most often injured organ is the spleen, followed by the liver and a hollow viscus, typically the small intestine. The leading cause of abdominal surgery is

• Blunt trauma results from a direct strike like a kick, hitting something or falling on a bicycle's handlebars, and experiencing an abrupt deceleration like a fall from a height or vehicle crash.

• Gunshot wounds; the abdominal organs within the chest throughout the respiratory cycle; any penetration of the chest below the fourth intercostal gap, also known as the nipple line.

What Is the Pathophysiology of Abdominal Inflammation?

Intra-abdominal tissues may be lacerated or ruptured by blunt or penetrating trauma. Low-volume hemorrhage, or bleeding with little physiologic impact, is frequently caused by mild organ damage, vascular laceration, or hollow viscus laceration; profuse bleeding might result from more severe wounds. Later on, peritonitis allows the contents of the stomach, intestines, or bladder to enter the peritoneal cavity. Additionally, internal bleeds like intraperitoneal or retroperitoneal bleeding are also noticed.

What Are the Signs and Symptoms of an Abdominal Injury?

The common signs and symptoms of abdominal injury are

• Mild to moderate pain in which the pain radiates to the left shoulder as a result of a splenic injury. Small intestinal perforations often cause mild discomfort that gradually worsens within the first few hours.

• Skin laceration.

• Hematuria as a result of renal damage.

• Tachycardia (increased heartbeat).

• Hypovolemia (decreased blood plasma).

• Hypotension (decreased blood pressure).

• Confusion.

• Disorientation.

• Unusual or strange behavior.

• Ecchymosis (bruising or bleeding under the skin).

• Peritonitis (inflammation of the abdominal wall).

• Intraperitoneal bleeding.

• Perineal hematoma (blood clot around the anus).

How to Diagnose Abdominal Injury?

The diagnosis of the abdominal injury is based on a physical examination and a history of signs and symptoms. Abdominal injury, more precisely evaluated by imaging techniques and laboratory investigations, are

• X-rays evaluate the diaphragm and an elevated hemidiaphragm, indicating hollow viscus perforation and rupture. Therefore, a pelvis x-ray is recommended based on clinical examination.

• CT: When the diagnosis is inconclusive with other examinations, computed tomography is used to evaluate a definite diagnosis of intra-abdominal damage.

• Ultrasound: Focused Assessment for Trauma Ultrasound (FAST US) is combined with three dimension imaging to rule out abnormal pericardial fluid or intraperitoneal free fluid.

• Laboratory Investigation: Laboratory findings involve urine analysis to detect hematuria (blood in urine) and complete blood count (CBC). Blood type and cross-match are seen in advance for blood transfusion.

• Surgical Laparotomy is indicated rarely in the following conditions are

  • Peritonitis (inflammation of the abdominal wall).

  • Hemodynamic instability (force of blood flow within artery and vein).

  • Gunshot wounds.

• Diagnostic Peritoneal Lavage (DPL): A peritoneal dialysis catheter is placed into the pelvic/peritoneal cavity through the abdominal wall. The positive aspiration of blood is a definite sign of abdominal injury.

What Are the Treatment Options for Abdominal Injury?

1. Most musculoskeletal and abdominal injuries may be treated with rest and ice.

2. However, surgery may be necessary for intra-abdominal injuries, especially if the liver, kidney, or spleen are involved.

3. When there are no peritoneal signs still, patients are advised to be in observation to identify ongoing bleeding and peritonitis.

4. A complete blood count (CBC) is performed every four to six hours to evacuate the decrease in hematocrit. If necessary, certain unstable patients might be able to have an angiographic embolization (which arrests the bleeding artery without surgery) and immediate surgery.

Conclusion

The abdomen is a region of the body that is not well protected. In addition to lacking a protective structure, its sensitivity to injury is heightened by its size, intermediate placement on the body, and proportion to its surface area. The medical professional treating the athlete in the stadium or arena must be aware of the signs and symptoms, potential risks, as well as the mechanism of injury for many of these common injuries in order to properly treat the athlete and determine whether "proper treatment" entails keeping them out of the game or transporting them to emergency care. The seriousness of any injury should not be underestimated, and abdominal injuries can be fatal. Understanding abdominal injuries is important since they have the potential to be among the worst for athletes. However, with the proper education and training, these injuries can be efficiently treated on and off the field.