Most Likely Injured Organ in Pediatric Blunt Abdominal Trauma
The spleen (Option B) is the most likely injured organ in this 9-year-old with bicycle trauma and upper abdominal pain, as it is the most commonly injured solid organ in pediatric blunt abdominal trauma. 1, 2, 3, 4
Epidemiologic Evidence
- The spleen is definitively the most frequently injured organ in blunt abdominal trauma in children, often being the only organ injured 5, 3, 4
- Bicycle handlebar injuries specifically create a mechanism that commonly results in splenic trauma due to direct compression against the left upper quadrant 1
- The liver is the second most common organ injured, but less frequently than the spleen in pediatric populations 4, 6
- Pancreatic injuries are relatively rare in blunt abdominal trauma, though handlebar mechanisms can occasionally cause them 7
- Renal injuries are uncommon in this clinical scenario 4
Clinical Presentation Supporting Splenic Injury
- Upper abdominal pain, particularly left-sided, with referred left shoulder pain is characteristic of splenic trauma in children 1
- The patient's hemodynamic stability does not exclude splenic injury, as splenic rupture can present with only mild symptoms initially 5, 8
- The elastic pediatric rib cage transmits force into the abdominal compartment more readily than in adults, making splenic injury more likely even without rib fractures 1
Diagnostic Approach When FAST is Non-Conclusive
- FAST has poor sensitivity (50-92%) for detecting splenic injury in children, with only 13.7% of pediatric trauma patients with suspected intra-abdominal injuries undergoing FAST examination 1, 2
- Contrast-enhanced CT scan is the gold standard and should be performed in this hemodynamically stable child with upper abdominal pain and non-diagnostic FAST 1, 2, 7
- The World Journal of Emergency Surgery specifically recommends CT scanning in children at risk for injuries that might be missed by FAST, which includes this exact clinical scenario 2
Common Pitfall to Avoid
Do not rely on a negative or inconclusive FAST to exclude significant injury—FAST frequently misses splenic injuries in children and should never be the sole diagnostic test 7. The combination of mechanism (bicycle trauma), location of pain (upper abdomen), and hemodynamic stability makes this patient an ideal candidate for CT imaging rather than observation alone 1, 2.