Trauma to the abdomen with signs of blood loss and peritoneal contamination indicates which type of injury?

• A. Solid visceral organ injury
• B. Hollow visceral organ injury (stomach, small bowel, colon)
• C. Diaphragmatic injury
• D. Urologic injury

Answer: (B)

When the abdomen is injured and there are signs of blood loss plus contamination of the peritoneal cavity, think about a hollow viscus rupture. Perforation of a stomach, small intestine, or colon releases luminal contents into the sterile peritoneal space, leading to chemical and bacterial peritonitis. That contamination drives the peritoneal signs and often a systemic inflammatory response, along with ongoing blood loss from the injured tract.

In contrast, solid organ injuries (like liver or spleen) mainly cause bleeding into the abdomen (hemoperitoneum) without luminal contents leaking into the peritoneum, so the presentation centers on hemorrhage rather than contamination. Diaphragmatic injuries and urologic injuries have different hallmark features (respiratory compromise and herniation for diaphragmatic injury; hematuria for urologic injury) and don’t centrally involve peritoneal contamination from luminal contents.