Child With Abdominal Pain and Swelling After Car Accident

June 5, 2015

The child is alert and able to speak. Physical examination reveals abdominal contusions and inguinal lacerations. The abdomen is distended and painful to the touch. Watch the video, review the history, and make your diagnosis.

A 4-year-old girl is brought to the ED after the car she and her mother were in was hit by another vehicle. She is awake and alert and able to speak. Physical examination reveals contusions and abrasions on the abdomen, consistent with seat belt sign, and inguinal lacerations. On palpation, the abdomen is distended, hard, and painful. She is afebrile; weight, 23.7 kg; heart rate, 124 beats/min; respiratory rate, 28 breaths/min; blood pressure, 124/73 mm Hg; SpO2, 100% on room air.

CT scans are ordered of the abdomen and pelvis and the head. Plain x-ray films are ordered of the full spine. Trauma labs are ordered, including CBC, CMP, PT/PTT/INR, and amylase level.

What do you suspect is the primary cause of the child’s abdominal distress?