## Most Common Organ Injured in Blunt Abdominal Trauma **Key Point:** The spleen is the most frequently injured solid organ in blunt abdominal trauma, accounting for approximately 40–50% of all blunt splenic injuries in trauma patients. ### Why the Spleen? 1. **Anatomical factors:** - Highly vascular organ with fragile capsule - Fixed position in left upper quadrant (LUQ) - Vulnerable to direct impact and deceleration forces 2. **Mechanism of injury:** - Motor vehicle collisions (MVC) with left-sided impact - Falls from height - Blunt force to left flank or lower chest ### Comparison of Common Blunt Abdominal Injuries | Organ | Frequency | Mechanism | FAST Window | |-------|-----------|-----------|-------------| | Spleen | 40–50% | Deceleration, LUQ impact | Left upper quadrant | | Liver | 30–40% | RUQ impact, deceleration | Right upper quadrant | | Small intestine | 5–10% | Compression, shear | Periumbilical free fluid | | Pancreas | <5% | Crush injury, seat belt | Retroperitoneal (not seen on FAST) | **Clinical Pearl:** Although the liver is the most commonly injured organ overall (including penetrating trauma), the spleen is the most common in **blunt trauma alone**. This distinction is critical for NEET PG. **High-Yield:** FAST examination detects free fluid in four windows: RUQ (Morrison's pouch), LUQ (splenorenal recess), pelvic, and pericardial. Splenic injuries appear as fluid in the **left upper quadrant (splenorenal recess)**. **Mnemonic:** **FAST** = **F**ocused **A**ssessment with **S**onography for **T**rauma — four views (RUQ, LUQ, Pelvis, Pericardium). ### Management Implications - Grade I–III splenic injuries: **non-operative management** (NOM) with ICU/HDU monitoring in haemodynamically stable patients - Grade IV–V or haemodynamic instability: **splenectomy** indicated - Splenic artery embolization (SAE) is an adjunct in select Grade III–IV cases [cite:ATLS 10th Edition, Chapter 5]
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