Help diagnosing a sudden, sharp abdominal pain from injury?
July 15, 2014 6:07 PM   Subscribe

A middle-aged female neighbor, Rachel, fell down a long flight of carpeted stairs yesterday while sleepwalking. She seems okay and says she's very fortunate as she hit everything several times including her head. They made the decision not to go to the hospital and we neighbors did our best to help. Today she's doing very well but we wonder from her description of a sharp pain upon landing whether she might have a fractured rib. I've already read this post about rib fracture.

When it became clear that we were not going to convince her to go to the ER we (three neighbors, one an RN) did the best we could to evaluate pupils, vision, bones, and anything else we could think of. She says she never lost consciousness once the sensation of falling woke her. We reached her less than an hour after the fall but we had her husband check her temp. throughout the night because of something curious she said. When she landed at the foot of the stairs, on her back with quite bit of force, she felt a big, sharp pain in her abdomen, as if something snapped or burst. It subsided immediately. The spot is hard to pinpoint because she's tender everywhere but it's definitely in the upper left quadrant of her abdomen, perhaps as high as the lowest rib, which is our RN's best guess. Rachel says she's not sure but she thought it might have been deeper inside than her ribs. She's had no fever and her urine, BM, and breathing appear normal. She says she's pulled something (she doesn't recall the name) in her ribs from coughing before and this was much sharper and more painful.

Could this be anything apart from a rib, knowing you're not her, or our, doctor?
posted by R2WeTwo to Health & Fitness (7 answers total) 1 user marked this as a favorite
Best answer: FWIW, I've had broken ribs where the pain *felt* deeper than rib-level.

If the ER isn't an option, does she have access to a regular doctor she'd agree to call in the morning?
posted by The Underpants Monster at 6:31 PM on July 15, 2014

Best answer: Twice in her life (at least) my mother has broken a rib and injured a lung, without having symptoms that she considered "bad enough" to go to the hospital. As you can imagine, this did not go well.

I know you can't make your neighbor go to the doctor/urgentcare/hospital, but seeing a doctor is the only wise course of action here.
posted by Coatlicue at 6:34 PM on July 15, 2014 [4 favorites]

Best answer: I've seen people suffer severe spleen ruptures from less significant trauma than that. Would likely present as sharp left upper quadrant pain. This can be a surgical emergency. She should go to the emergency room.
posted by jhs at 6:40 PM on July 15, 2014 [3 favorites]

Response by poster: Thanks, everyone. We'll make sure we at least help her call her doctor tomorrow and I'll report back here how it goes.
posted by R2WeTwo at 7:35 PM on July 15, 2014 [1 favorite]

Best answer: I landed wrong when I fell from a pony at age 10. What my parents thought must be a cracked rib did indeed turn out to be a ruptured spleen. But it was a dull and persistent pain, not sharp and fleeting. But internal bleeding can present both ways.

Please do post an update. She s probably fine, but now we'll worry!
posted by SLC Mom at 8:39 PM on July 15, 2014

Best answer: It could be something else serious but unlikely to be a broken rib if the pain was brief. Broken ribs generally cause pretty severe pain for weeks until they heal.
posted by treehorn+bunny at 10:26 PM on July 15, 2014 [1 favorite]

Response by poster: Apologies for the delay posting. After a long visit with an excellent trauma team we're delighted to report that Rachel is fine. Everyone affirmed how lucky she was, and a story of one of the nurses was especially sobering. She fell down a similar flight of stairs and, hitting her head on the wall, ended up with a concussion as well as a broken arm and seriously messed up back and hip. Six months later she's still feeling the changes. Today we learned that Rachel's head landed less than an inch from a sort of floorboard sconce/light with very angled edges. My girl will do a few weeks of PT for a torn meniscus but that's it. Thanks again, really, for your kind responses.
posted by R2WeTwo at 8:14 PM on July 16, 2014 [1 favorite]

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