Expanding Abdominal Bruise in Child After Bike Fall: Medical Evaluation Needed

A bruise (ecchymosis) that enlarges after 5 days in a child following handlebar or abdominal trauma is a red flag for ongoing internal bleeding and requires prompt medical assessment.

Concerning Etiologies

• Solid organ injury: Splenic or hepatic laceration (handlebar mechanism). Delayed rupture possible.
• Hollow viscus perforation: Duodenum, jejunum → peritonitis (delayed presentation).
• Retroperitoneal hematoma: Expands along fascial planes; may track to flank/perineum.
• Vascular injury: Mesenteric vessel tear, pseudoaneurysm.
• Coagulopathy: Undiagnosed (von Willebrand, hemophilia) or acquired (vitamin K deficiency, sepsis).
• Abdominal wall hematoma: Rectus sheath bleeding (expands in confined space).

Immediate Actions

1. Seek evaluation today: Pediatrician, urgent care, or ER. Do not wait.
2. Do not massage or apply heat (increases bleeding).
3. Ice packs: 15 min on/off (cloth barrier) for comfort/vasoconstriction.
4. Analgesia: Acetaminophen preferred. Avoid NSAIDs (ibuprofen) if bleeding concern until evaluated.
5. Monitor: Vital signs, abdominal distension, tenderness, guarding, vomiting, urinary output, lethargy.

Expected Workup

• CBC, coags (PT/INR, PTT), LFTs, amylase/lipase, urinalysis.
• FAST ultrasound (trauma screen) or formal abdominal US.
• CT abdomen/pelvis with contrast (gold standard for solid organ/vascular injury).

Red Flags for Emergency Department

• Hemodynamic instability (tachycardia, hypotension, pallor)
• Peritoneal signs (rigidity, rebound, guarding)
• Altered mental status
• Bruise crossing midline or extending to flank/back (Grey Turner) / periumbilical (Cullen)

Prevention

Handlebar pads, proper bike fit, helmet, supervised riding. Teach tuck-and-roll fall technique.