[4][6] The injury may present with abdominal pain, tenderness,[7] distension, or rigidity to the touch, and bowel sounds may be diminished or absent.

[4] In children, bicycle mishaps are also a common cause of abdominal injury, especially when the abdomen is struck by the handlebars.

[10] Gunshot wounds that penetrate the peritoneum result in significant damage to major intra-abdominal structures in some 90 percent of cases.

[11] Solid abdominal organs, such as the liver and kidneys, bleed profusely when cut or torn, as do major blood vessels such as the aorta and vena cava.

[11] Hollow organs such as the stomach, while not as likely to result in shock from profuse bleeding, present a serious risk of infection,[11] especially if such an injury is not treated promptly.

The liver, the most vulnerable abdominal organ to all forms of injury because of its size and location (in the upper right quadrant of the abdomen), is injured in about five percent of all people admitted to a hospital for trauma.

[9] Spleen is the most common cause of massive bleeding in blunt abdominal trauma to a solid organ.

However, unlike the liver, penetrating trauma to the spleen, pancreas and kidneys do not present as much of an immediate threat of shock unless they lacerate a major blood vessel supplying the organs, such as the renal artery.

[5] Ultrasound can detect fluid such as blood or gastrointestinal contents in the abdominal cavity,[1] and it is a noninvasive procedure and relatively safe.

[4] CT is able to detect 76% of hollow viscous injuries so people who have negative scans are often observed and rechecked if they deteriorate.

[15] However, CT has been demonstrated to be useful in screening people with certain forms of abdominal trauma in order to avoid unnecessary laparotomies, which can significantly increase the cost and length of hospitalizations.

[16] A meta-analysis of CT use in penetrating abdominal traumas demonstrated sensitivity, specificity and accuracy >= 95%, with a PPV of 85% and an NPV of 98%.

[1] If this does not reveal evidence of injury, sterile saline is infused into the cavity and evacuated and examined for blood or other material.

[1] While peritoneal lavage is an accurate way to test for bleeding, it carries a risk of injuring the abdominal organs, may be difficult to perform, and may lead to unnecessary surgery; thus it has largely been replaced by ultrasound in Europe and North America.

The initial treatment involves stabilizing the person enough to ensure adequate airway, breathing, and circulation, and identifying other injuries.

[1][5] The main goal is to stop any sources of bleeding before moving onto any definitive find and repair any injuries that are found.

[18] Due to the time sensitive nature, this procedure also emphasizes expedience in terms of gaining access and controlling the bleeding, thus favoring a long midline incision.

[19] Intra-abdominal injuries are also frequently successfully treated nonoperatively as there is little benefit shown if there is no known active bleeding or potential for infection.