A 23-year-old presents after blunt trauma with left shoulder pain and abdominal tenderness; Hb 10 g/dL and WBC 11,000. The most likely diagnosis is which organ injury?

A 23-year-old presents after blunt trauma with left shoulder pain and abdominal tenderness; Hb 10 g/dL and WBC 11,000. The most likely diagnosis is which organ injury?

• A. Pancreatic injury
• B. Liver laceration
• C. Ruptured spleen
• D. Kidney injury

Answer: (C)

Left shoulder pain after blunt abdominal trauma is a classic sign of diaphragmatic irritation from intra-abdominal bleeding, known as Kehr sign. The spleen sits in the left upper quadrant and is highly vulnerable to rupture; when it tears, blood collects in the peritoneal cavity and irritates the diaphragm, producing referred pain to the left shoulder via the phrenic nerve. The low hemoglobin indicates blood loss, and a mild leukocytosis can accompany trauma. Among the possibilities, splenic rupture best fits this pattern of left shoulder pain with abdominal tenderness and evidence of blood loss. Pancreatic injury usually causes epigastric pain; liver injury tends to produce right upper quadrant symptoms; kidney injury presents with flank pain and hematuria, not referred shoulder pain.

Left shoulder pain after blunt abdominal trauma is a classic sign of diaphragmatic irritation from intra-abdominal bleeding, known as Kehr sign. The spleen sits in the left upper quadrant and is highly vulnerable to rupture; when it tears, blood collects in the peritoneal cavity and irritates the diaphragm, producing referred pain to the left shoulder via the phrenic nerve. The low hemoglobin indicates blood loss, and a mild leukocytosis can accompany trauma. Among the possibilities, splenic rupture best fits this pattern of left shoulder pain with abdominal tenderness and evidence of blood loss. Pancreatic injury usually causes epigastric pain; liver injury tends to produce right upper quadrant symptoms; kidney injury presents with flank pain and hematuria, not referred shoulder pain.