Causes of Right Lower Quadrant Contusion
Right lower quadrant contusions result primarily from direct blunt trauma to the abdomen, most commonly from motor vehicle collisions, falls, sports injuries, or intentional physical violence such as punches to the abdomen.
Traumatic Mechanisms
Direct Blunt Impact
- Motor vehicle collisions are the most common cause of abdominal contusions, particularly high-speed impacts that can cause significant force transmission to the abdominal wall and underlying organs 1, 2.
- Direct blows from fists or objects can cause isolated abdominal wall contusions without necessarily causing rib fractures or internal organ injury 3, 4.
- Sports-related trauma including contact sports like wrestling, football, and soccer can cause abdominal muscle contusions through direct impact or sudden trunk movements 4.
- Falls from height can result in direct impact to the right lower quadrant 2.
Specific Injury Patterns in the RLQ
Abdominal wall injuries include rectus abdominis strains, oblique muscle strains, and contusions from direct blows or sudden repetitive trunk rotation or flexion/extension movements 4.
Associated injuries that may accompany RLQ contusions from high-energy blunt trauma include:
- Pelvic or hip fractures and dislocations 1
- Lumbar spine fractures 1
- Lower rib fractures 1
- Soft tissue ecchymosis and hematomas 1
Indirect Traumatic Mechanisms
Avulsion fractures at muscular attachment sites can cause traumatic edema, hematoma, or inflammation in the RLQ region, particularly:
- Hamstring avulsions at the ischial tuberosity 1
- Adductor muscle avulsions at the inferior pubic symphysis 1
Iatrogenic causes include injury following gynecologic surgery, genitourinary surgery, or total hip arthroplasty that may result in contusion or hematoma formation in the RLQ 1.
Clinical Considerations
Seat belt sign across the lower abdomen following motor vehicle collision should raise suspicion for underlying abdominal wall contusion and potential internal injuries 1.
Delayed presentation is common, as pain from abdominal contusions may not manifest immediately and can present 6-24 hours or even up to 5 days after the initial injury 1.
Important Pitfalls
Do not assume isolated contusion - even with intact ribs, significant internal organ injuries (including liver, pancreas, duodenum, or small bowel) can occur from blunt abdominal trauma due to different material characteristics and injury tolerances of various tissues 3, 2.
Hematoma formation from contusions can compress adjacent nerves or develop into rectus sheath hematomas, particularly in patients on anticoagulation 1, 4.
High-energy mechanisms warrant comprehensive imaging evaluation even when external signs appear minimal, as mortality and morbidity rates are significantly elevated with high-impact trauma 2.