A bomb blast victim presents with nausea and abdominal pain, and a CT scan shows no hemorrhage. What treatment should be recommended?

• A. Admit for observation 12 to 24 hours in case a hematoma develops
• B. Discharge home with instructions
• C. Immediate surgery
• D. Administer antibiotics and discharge

Answer: (A)

In blast injuries, a negative CT does not guarantee there won’t be evolving abdominal injury. The blast wave can cause occult hollow-viscus or mesenteric damage that isn’t immediately evident, and symptoms like nausea and abdominal pain can precede signs of deterioration. Because of this, the safest approach for a stable patient with abdominal symptoms but no CT evidence of hemorrhage is admission for close observation for a period, typically 12 to 24 hours, with serial physical exams and monitoring for any new or worsening signs. This allows timely detection and treatment if a delayed injury develops, such as a hollow-viscus perforation or a developing hematoma.

Discharging home with instructions would risk missing a delayed injury that could progress to peritonitis or sepsis. Immediate surgery isn’t warranted without signs of acute abdomen or hemodynamic instability, given the current imaging and exam findings. Administering antibiotics and discharging would address infection but not a potential structural injury that might require operative management if it evolves.