Author: William Manning, MD
Co Author #1: Mallory Shasteen, MD
Editor: Eugene Palatulan, MD
17 year old previously healthy male kicker (no medications, medical problems, surgeries, or allergies) playing in a late season football game, evaluated on the sideline for abdominal pain.
The young man was tackled and struck in the mid-abdomen by a helmet during the second quarter of a football game while kicking the football. He reported having the wind knocked out of him but quickly felt better. He had a reassuring physical exam and returned to play approximately 15 minutes later. He was involved in a second tackle just before halftime and shortly thereafter developed increasing generalized abdominal pain. He was able to walk approximately 400m from the field to the training room for evaluation without change in abdominal pain and denied lightheadedness, dizziness, headache, chest pain, or shortness of breath.
His hear rate was at 90 bpm and respiratory rate of 20 per minute with equal chest rise. Abdomen without distention. No skin changes or deformities noted to abdomen, flank, or chest wall bilaterally. Chest wall and ribs were non-tender to palpation and there was no CVA tenderness. Diffuse abdominal tenderness to palpation with guarding was noted, worse in LUQ just inferior to costal margin. He reported nausea and left shoulder pain that was not reproducible with palpation or ROM.
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