Assessing Potential Kidney or Spleen Injury After a Back Impact

Q: Assessing Potential Kidney or Spleen Injury After a Back Impact

Dear Mr. Q： 1. Given the left lower back pain due to external impact, it is indeed necessary to consider potential injuries to the kidneys, spleen, mesentery, ureters, intestines, and other related structures. 2. In your case, although there is a skin wound, the

Impact injury to the left lower back?

Hello Doctor: Today while playing with friends, one of them accidentally hit my left lower back with a pillow quite hard (although the pillow is relatively soft).
At that moment, there was swelling on my left lower back due to the zipper on the pillow, and I can see a red swollen spot on the skin (which should be a bruise).
It only hurts when I press on it; otherwise, there is no pain.
Is there a possibility that this could cause kidney injury with bleeding or splenic rupture with bleeding? Since the impact was quite strong, I usually don't feel any abnormalities or pain in the swollen area unless I press on it, and I don't think I have hematuria.
Should I go to the hospital for an examination, or can I observe it for a few days? If I need to get checked, which department should I visit? Thank you.

Xiao Q, 30~39 year old female. Ask Date: 2017/10/13

Dr. Xiao Yongxun reply Internal Medicine

Dear Mr.
Q:
1.
Given the left lower back pain due to external impact, it is indeed necessary to consider potential injuries to the kidneys, spleen, mesentery, ureters, intestines, and other related structures.
2.
In your case, although there is a skin wound, the absence of hematuria, rebound tenderness in the abdominal wall, intestinal bleeding, and severe abdominal pain suggests that there should not be any major issues.
3.
As for the wound, maintaining cleanliness and preventing secondary infections should suffice, and it should heal in about a week.
For the bruised area, applying heat can help accelerate the resolution and absorption of the hematoma.
4.
Of course, if discomfort persists or you remain concerned, I recommend seeking assistance from a urologist or a general surgeon.
[Note] I apologize for the delayed response due to issues with my personal operating system.

Reply Date: 2017/10/13

More Info

When assessing potential kidney or spleen injury after a blunt impact to the back, such as the incident you described where a pillow struck your left lower back, it's essential to consider several factors. While the impact was from a soft object, the force applied can still lead to underlying injuries, especially if there was significant swelling or bruising at the site of impact.

Potential Injuries
1. Kidney Injury: The kidneys are located in the retroperitoneal space, which means they are somewhat protected by surrounding structures. However, they can still be injured by blunt trauma. Symptoms of kidney injury may include:
- Hematuria (blood in urine), which may not always be present.

- Flank pain, which can be severe.

- Abdominal pain or tenderness.

- Signs of internal bleeding, such as dizziness or fainting.

2. Spleen Injury: The spleen is also located in the upper left quadrant of the abdomen and can be susceptible to injury from blunt trauma. Symptoms of a splenic injury may include:
- Pain in the left upper abdomen or shoulder.

- Signs of internal bleeding, such as lightheadedness or a rapid heart rate.

- Bruising in the abdominal area.

Your Symptoms
In your case, the presence of swelling and tenderness at the site of impact, along with the absence of pain when not pressing on the area, suggests that the injury may be localized to the soft tissue rather than a significant organ injury. However, the fact that you experienced a notable impact means that monitoring your symptoms is crucial.

Recommendations
1. Observation: If you are not experiencing severe pain, blood in your urine, or any other concerning symptoms, you may choose to monitor your condition for a few days. However, if any of the following occur, you should seek medical attention immediately:
- Increased pain or swelling.

- Development of new symptoms such as fever, chills, or nausea.

- Any signs of internal bleeding, such as lightheadedness or fainting.

2. Medical Evaluation: If you have persistent pain, especially if it worsens or if you develop new symptoms, it would be prudent to seek medical evaluation. You should consider visiting an emergency department or your primary care physician. They may perform imaging studies, such as an ultrasound or CT scan, to assess for any internal injuries to the kidney or spleen.

3. Specialty Consultation: If imaging indicates a potential injury, you may be referred to a specialist, such as a urologist for kidney issues or a general surgeon for spleen-related concerns.

Conclusion
In summary, while your symptoms currently suggest a localized soft tissue injury, it is essential to remain vigilant for any changes in your condition. If you have any doubts or if your symptoms change, do not hesitate to seek medical attention. Early diagnosis and management are key to preventing complications from any potential internal injuries.

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