In blunt abdominal trauma, which findings suggest hollow viscus injury?

• A. Delayed abdominal pain, signs of peritoneal irritation, fever, leukocytosis; free air on imaging.
• B. Immediate colicky back pain.
• C. Isolated left flank pain.
• D. No fever.

Answer: (A)

Hollow viscus injuries after blunt trauma often don’t show up right away. The hallmark is a progression from subtle symptoms to clear signs of irritation as contents leak into the abdomen. Delayed abdominal pain with signs of peritoneal irritation reflects evolving peritonitis from a perforation or leakage. Fever and leukocytosis indicate the body’s inflammatory response to contamination in the peritoneal cavity. Finding free air on imaging provides direct evidence that a hollow organ (like the bowel) has perforated. Taken together, these findings make hollow viscus injury the most likely diagnosis.

Other patterns don’t fit as well because they lack the combination of peritoneal irritation and evidence of perforation. Immediate back pain or isolated flank pain points away from intra-abdominal hollow organ injury, and absence of fever, while not ruling out early injuries, does not explain peritoneal signs or free air.