The absence of external visual findings does not exclude intra-abdominal pathology, as up to 20% of patients with intra-abdominal injury may not display these findings upon initial examination. Visual inspection for signs of external trauma such as abrasions, lacerations, contusions, and classic seatbelt sign on the abdomen is helpful. It is important to ask focused questions regarding previous surgical history, hepatic disease process, recent infections, anticoagulant, aspirin or nonsteroidal anti-inflammatory usage and bleeding disorders. The absence of substantial trauma cannot exclude the possibility of splenic injury, as individuals with a history of splenomegaly require less force for traumatic rupture. Trauma is the most common mechanism of injury, and blunt trauma involving the left-upper quadrant, left rib cage, or left flank should raise suspicion for splenic involvement.
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