Worsening left upper quadrant pain after a football injury.

An 18-year-old man was playing football at a local university when he was hit in the stomach with an opponent’s helmet. He immediately experienced left upper quadrant abdominal pain. Despite taking a rest on the sidelines, his pain increased. Upon arrival at the emergency department, the patient’s vital signs were as follows: temperature, 37.8°C (100.1°F); pulse, 110 beats per minute; respiratory rate, 24 breaths per minute; oxygen saturation, arterial, 100% on room air; and blood pressure, 148/72 mm Hg. He rated the intensity of his pain at “6 out of 10.” The patient’s medical history was unremarkable. The emergency physician’s primary assessment revealed that the patient had a patent airway with lungs that were clear to auscultation. His heart rhythm was regular, and all pulses were palpable. The prehospital paramedics had initiated an intravenous (IV) line of lactated Ringer’s solution at a keep vein open rate, and we started a second IV line of lactated Ringer’s solution at a keep vein open rate. Blood was drawn for a complete blood cell count, blood urea nitrogen, creatinine, electrolytes, prothrombin and partial thromboplastin time, amylase, lipase, type, and hold. The patient denied loss of consciousness. His pupils were equal and reactive to light, and he was alert and oriented to person, place, and time. No neurologic deficit was noted. Twenty minutes after admission to the emergency department, the patient complained that the stabbing pain in his left upper quadrant now involved his left lower quadrant. The severity of the pain was unchanged. We administered meperidine 75 mg intramuscularly. Twenty minutes later, the patient reported that his pain was “2 out of 10” and he was “much more comfortable.” Worsening Left Upper Quadrant Pain After A Football Injury