Abdominal Injury - Football

HISTORY: A 15-year-old high school football player sustained a blunt abdominal injury to the left side of his torso while tackling an opposing player during a scrimmage. Patient attempted to make a tackle and when he did, the opponent’s helmet struck the left side of his thorax and subsequently the opponent's knee struck the same area directly afterwards. He felt like he "got the wind knocked out" of him. He removed himself from the remainder of the scrimmage and did not notify his athletic trainer. Two days later, he presented to the pediatric emergency department with ongoing symptoms of left-sided abdominal pain that was worse with deep inspiration. There was no head strike, loss of consciousness, nausea, vomiting, dizziness, fevers, change in appetite, bowel/bladder changes, hematuria, radiation of his pain. PHYSICAL EXAMINATION: Examination in the emergency department revealed patient awake and alert, no abdominal or thoracic bruising, no rib tenderness. Abdomen was soft with very mild tenderness over the left flank. Vitals: afebrile, blood pressure 102/52, heart rate 71. DIFFERENTIAL DIAGNOSIS: 1. Chest wall contusion 2. Rib contusion/intercostal strain 3. Traumatic pancreatitis 4. Traumatic splenic injury 5. Pulmonary Contusion TEST AND RESULTS: Laboratory work-up unremarkable without anemia, leukocytosis, electrolyte abnormalities, renal impairment, transaminitis, or elevated lipase. No microscopic hematuria on urinalysis. Point-of-care ultrasound with FAST (focused assessment with sonography for trauma): Negative for free fluid in the abdomen. Orthostatic Vital signs: Positive. Pulse from sitting to standing increased from 76 to 98, Blood Pressure sitting to standing 122/58 to 114/50 with symptoms. This positive result prompted further work-up with CT scan. CT Abdomen with IV contrast: Grade 3 spleen laceration with small subcapsular hematoma. FINAL WORKING DIAGNOSIS: Traumatic splenic laceration TREATMENT AND OUTCOMES: Discharged from hospital the following day after period of observation. No contact sports or physical education for 6 weeks, follow up with pediatric surgery team in 4 weeks. At 4 week follow up with surgery, patient doing well with plan to ease back into activity at 6 weeks.