Abdominal haematoma After Car Accident

Definition of abdominal haematoma

A haematoma is when blood gathers outside of the blood vessels, usually due to bleeding from a damaged vessel. The location of the haematoma determines what it's called, thus abdominal haematoma is that in the abdomen. Abdominal haematomas can be either intraabdominal (within the abdomen) or abdominal wall haematomas.¹ If it occurs on the walls of the abdomen it's most often caused by bleeding in the rectus muscle, which is called a rectus sheath haematoma which is more commonly found than the lateral abdominal wall haematomas, which are less common.² 

Causes of abdominal haematoma

The reason behind abdominal haematoma can be linked to factors such as bleeding tendency, use of anticoagulants, or injury to blood vessels. This type of injury can happen due to external trauma to the abdomen, surgical procedures, or intense muscle contractions during activities that involve the Valsalva maneuver (like severe vomiting or straining). In some cases, it may occur without any apparent cause in patients with severe hypo-coagulability such as haemophilia, Von-Willebrand disease or sometimes while they are receiving anticoagulant treatment. Although rare, spontaneous rectus sheath haematoma may also arise during pregnancy, laparoscopic cholecystectomy, or even abdominal insulin injections. The rupture of an inferior epigastric artery is also one of the possible causes of such haematomas.^1,2  

Symptoms

Common signs and symptoms

Abdominal discomfort and its linked symptoms such as nausea and vomiting. The discomfort usually appears suddenly, is intense, and does not spread to other areas.¹ Also, the patient may show fever, anaemia, bruising, and low blood pressure.

Emergency symptoms

In very uncommon instances, the haematoma might be significant and result in low blood volume, fast heart rate, and rapid breathing.¹

Diagnosis

Physical examination and medical history

The physical examination typically identifies a solid lump in a particular area of the body that does not pulsate (beat). If there is a mass in the abdominal wall that doesn't cross the midline or change with flexion of the rectus muscles, it's known as the Fothergill sign. This sign indicates a rectus sheath haematoma and helps determine whether the mass is within the abdominal wall or in the intraabdominal cavity. However, this sign is not very sensitive and can be inconclusive for obese patients.¹

To make an accurate diagnosis, the healthcare provider will gather your detailed medical history to assess any risk factors such as a history of surgery, coughing, constipation, asthma, bronchitis, anticoagulation therapy, and the use of oral corticosteroids and anticoagulants.¹

Diagnostic tests

Detecting a rectus sheath haematoma can be challenging as its symptoms resemble those of other medical conditions. Diagnostic tests include:

Basic blood work

Your healthcare provider will request a blood test to measure your haemoglobin and haematocrit levels. More than 50% of individuals with a rectus sheath haematoma have markedly low levels of haemoglobin.¹ 

Imaging

• Ultrasound of your abdominal wall is the initial imaging test that is usually done. It indicates fluid collection, the location within the abdominal wall, and possibly reveals the size of the haematoma¹
• If the ultrasound study is inconclusive, a CT scan is the next test. This test provides more in-depth information on the location, size, and extension of the haematoma. Administering intravenous contrast during the CT scan can detect any active bleeding by showing where the dye has escaped from an injured artery, thus allowing your provider to determine where the rupture occurred

Treatment options

The management of abdominal haematomas is determined by various factors including the intensity of symptoms, the size of the haematoma, its stability, and the underlying cause.¹

The majority of abdominal haematomas typically resolve on their own without the need for medical treatment. These haematomas can be managed with home remedies like ice or cold compressions, rest, and over-the-counter pain relievers. Approximately 80% of rectus sheath haematomas can be treated conservatively using these methods. 

However, if these treatments are ineffective or the condition is severe, in cases where the haematoma is expanding rapidly and causing significant blood loss, a healthcare provider’s first-line approach is to perform an angioembolisation procedure. This is a non-invasive technique which involves imaging the blood vessels and blocking off the bleeding artery. 

If angioembolisation does not effectively control the bleeding, surgical ligation of the bleeding vessel may be necessary. During surgical intervention, the haematoma is removed and the bleeding artery is closed off.¹ 

Abdominal haematoma after a car accident

Impact of car accidents on abdominal haematoma

Most abdominal injuries seen in the Emergency Department are caused by blunt abdominal trauma (BAT), which is often related to motor vehicle collisions or auto versus pedestrian accidents. BAT is responsible for significant morbidity and mortality, with about 13% of patients presenting with BAT also having intra-abdominal injuries. Damage to the internal organs, including bleeding, bruises, and injuries to the bowel, spleen, liver, and intestines. This can occur as a result of blunt force trauma to the abdomen. In addition, patients may experience injuries to their limbs or other body parts.³

Hollow organs can rupture due to a sudden increase in intra-abdominal pressure, such as when passengers wearing lap belts without shoulder attachments experience forceful compression of the abdomen. Solid organs are susceptible to injury from forces exerted against the anterior abdominal wall, especially in older adults and alcoholic patients with lax abdominal walls. Shearing forces from sudden deceleration can cause lacerations of both solid and hollow organs, tears at vascular pedicles, or stretch injuries to arteries. Fractured ribs or pelvic bones can also lacerate intra-abdominal tissue. 

Factors affecting the severity of abdominal haematoma after car accidents

Factors that contribute to the severity of the abdominal haematoma after an accident include:

• The type and speed of the vehicle involved
• Whether the vehicle rolled over (which increases the risk of serious injury)
• Where the person was located in the vehicle (which can affect the severity of their injuries)
• How much the passenger compartment was damaged (which is associated with an increased risk of injury)
• Whether seat belts were used and what type of seat belts were used
• Whether airbags were deployed
• Unrestrained victims are more likely to be injured than those who use seatbelts
• Steering wheel deformity predicts abdominal injury for front-seat passengers but not drivers
• Pedestrian injuries vary based on the size and speed of the vehicle and often result in injuries to the leg, torso, and head

Prevention and safety measures

Tips for preventing car accidents:

• Always wear a seat belt, and if you're travelling with children, make sure they use appropriate car and booster seats. You may need to bring your own
• Avoid driving at night, especially in unfamiliar or rural areas. Also, don't ride motorcycles unless you have to, and if you do, wear a helmet
• Before driving, make sure to acquaint yourself with the traffic regulations in your area
• Do not drink and drive, and only ride in marked taxis while wearing a seatbelt
• Steer clear of buses or vans that are crowded, overweight, or top-heavy
• Don't use mobile phones while driving, and avoid distractions like talking or texting on your cell phone while driving
• If you're tired, don't drive. Slowed reaction time increases the risk of an accident
• Stick to the speed limit to reduce your risk of an accident
• Never use drugs or drink alcohol before driving, and don't drive after taking medicine that makes you sleepy. Either have a designated driver or make arrangements for transportation to take you home
• If you're a parent, help your teenager become a safe driver by being a good role model with your driving habits. Talk to your teen about ways to reduce their risk of an accident, including avoiding tiredness and distractions while driving. Remind them to always wear a seatbelt and follow the speed limit
• Always put your child in a child safety seat that's appropriate for their age, height, and weight. The seat should have a harness and clip and be placed in the middle of the back seat, secured so it doesn't move more than an inch in any direction. Follow the instructions provided with the seat to ensure it's positioned and secured correctly, and ask your healthcare provider for more information if needed

Summary

Abdominal haematoma refers to a collection of blood in the abdominal cavity. This can occur due to a variety of reasons, including trauma or injury to the abdomen. When it comes to accidents specifically, abdominal haematomas can be caused by blunt-force trauma to the stomach or abdominal area. This can occur in car accidents, falls, or other types of accidents where the abdomen is impacted. Symptoms of an abdominal haematoma may include pain, swelling, and tenderness in the affected area. In severe cases, internal bleeding may occur, which can lead to further complications. Treatment for abdominal haematomas may vary depending on the severity of the injury but can include rest, pain medication, and in some cases, surgery to remove the haematoma. Therefore, the public has to be educated on safety measures to avoid these injuries.