What is the best course of action for a young male with no chronic medical history who presents with resolved abdominal pain and vomiting after a traumatic incident involving an 80-pound dog sitting on his abdomen, now tolerating oral intake with a normal bowel movement and no current symptoms of abdominal pain, nausea, or vomiting?

Management of Resolved Blunt Abdominal Trauma in a Young Male

This patient can be safely discharged home with clear return precautions, as he is now asymptomatic, hemodynamically stable, tolerating oral intake, and more than 24 hours post-injury with complete symptom resolution.

Clinical Assessment and Risk Stratification

This patient presents with a reassuring clinical picture following blunt abdominal trauma:

• Hemodynamic stability: No tachycardia, hypotension, or signs of ongoing bleeding 1
• Complete symptom resolution: No current abdominal pain, nausea, or vomiting; normal bowel function 1
• Tolerating oral intake: Successfully maintaining hydration and nutrition 1
• Time course: Vomiting episodes occurred immediately post-trauma and overnight, with none on the day of presentation, suggesting transient gastric irritation rather than evolving intra-abdominal pathology 2

The initial vomiting pattern (three episodes within hours of trauma, then resolution) is consistent with transient gastric upset from the compressive force rather than hollow viscus perforation or solid organ injury, which would typically show progressive or persistent symptoms 2, 3.

When Imaging and Admission Are NOT Required

For this specific patient, neither CT imaging nor hospital admission is indicated because:

• Severe abdominal injuries (AIS ≥3) requiring non-operative management necessitate admission for 24-hour continuous monitoring followed by 3-5 days of observation 1
• However, this patient has no current abdominal tenderness, no peritoneal signs, and complete symptom resolution, which effectively rules out significant intra-abdominal injury 1
• The mechanism (80-pound dog sitting on abdomen) represents relatively low-energy blunt trauma compared to motor vehicle accidents or high-velocity impacts 1
• Bowel perforation from blunt trauma typically presents with progressive peritoneal signs that develop over hours, not symptom resolution 1, 2

Critical Red Flags That Would Change Management

Immediate return to the emergency department is warranted if any of the following develop 1:

• Recurrent or new abdominal pain, especially if progressive or localized
• Recurrent vomiting or inability to tolerate oral intake
• Tachycardia (most sensitive early sign of intra-abdominal complications) 1
• Fever, rigors, or signs of infection (suggesting delayed bowel perforation or solid organ injury) 1
• Abdominal distension or change in bowel habits (constipation or bloody stools) 1, 3
• Dizziness, syncope, or weakness (suggesting delayed hemorrhage) 1
• Shoulder pain (referred pain from diaphragmatic irritation by blood or enteric contents) 1

Discharge Instructions and Follow-Up

Provide explicit return precautions emphasizing that:

• Most complications from blunt abdominal trauma occur within the first 5 days, with hemorrhagic complications peaking in the first 24 hours 1
• Delayed bowel perforation from mesenteric vascular injury can present 24-72 hours post-trauma with new-onset peritoneal signs 1, 3
• The patient should maintain light activity for 48-72 hours and avoid strenuous physical exertion 1
• A responsible adult should monitor the patient for the next 24 hours given the initial severity of symptoms 1

Routine follow-up with primary care in 3-5 days is reasonable to ensure continued resolution, though not mandatory if the patient remains asymptomatic 1.

Common Pitfalls to Avoid

• Over-imaging stable patients: CT scanning every patient with resolved blunt abdominal trauma leads to unnecessary radiation exposure and does not improve outcomes when clinical examination is reassuring 1
• Dismissing the mechanism: While an 80-pound dog represents significant force, the complete symptom resolution and normal examination make significant injury highly unlikely 1
• Inadequate return precautions: The most critical error is failing to educate the patient and family about specific warning signs, as delayed presentations of bowel injury carry significantly increased mortality 4, 3