Differential Diagnosis for Severe Abdominal Pain with Tenderness after RTA

Single Most Likely Diagnosis

• Hemoperitoneum due to splenic or hepatic rupture: This is the most likely diagnosis given the context of a recent road traffic accident (RTA) and the presentation of severe abdominal pain with tenderness. The force of the accident can cause blunt trauma to the abdomen, leading to rupture of solid organs like the spleen or liver, which in turn can cause hemoperitoneum.

Other Likely Diagnoses

• Intestinal perforation: The force of the RTA can also cause intestinal perforation, either due to direct trauma or due to a seatbelt injury. This would lead to peritonitis, presenting as severe abdominal pain and tenderness.
• Pancreatic injury: Blunt trauma to the abdomen can also injure the pancreas, leading to pancreatitis or a pancreatic leak, both of which can cause severe abdominal pain.
• Musculoskeletal injury: While not as immediately life-threatening, musculoskeletal injuries such as abdominal wall hematomas or muscle strains can also occur after an RTA and cause significant pain and tenderness.

Do Not Miss Diagnoses

• Aortic dissection: Although less common, aortic dissection is a potentially life-threatening condition that can be caused by the high-impact forces involved in an RTA. It presents with severe, tearing chest or abdominal pain and is a medical emergency.
• Ruptured abdominal aortic aneurysm: This is another critical condition that could present with severe abdominal pain and tenderness after an RTA, especially in older patients.
• Ureteral or bladder injury: These injuries can occur due to the trauma and might not be immediately apparent but can lead to significant complications if missed.

Rare Diagnoses

• Diaphragmatic rupture: This is a rare but possible injury after an RTA, where the diaphragm is torn, potentially allowing abdominal contents to herniate into the thoracic cavity.
• Mesenteric ischemia: This could occur due to trauma causing a thrombus or embolus in the mesenteric arteries, leading to bowel ischemia and potentially severe abdominal pain.

Each of these diagnoses requires careful consideration and appropriate diagnostic workup to ensure timely and effective management of the patient's condition.