Bluntly put: Bored. Review.

Wrestlemania1

Its WrestlMania XIII 1997, and the Undertaker is soon to destroy Syncho Sid thanks to Bret Hart hitting Sid in the abdomen with a metal chair.

You are sad for Sid and start wondering:

What is the most likely intra-abdominal organ that Syncho injured in this blunt abdominal trauma?

The Spleen is organ most often damaged. In 2/3 of cases it is the only intraperitoneal organ to be damaged.
Most common mechanism of splenic injury is motor vehicle collision (MVC).
Splenic injury can be managed conservatively.
There is a grading system for splenic injury, but it is super boring.

shattered-spleen-grade-v-splenic-injury multi-organ-trauma-with-grade-v-renal-injury

Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 25533

Any idea what organ is the second most likely

Liver.

Most common organ to be injured in all-comers with abdominal trauma.

What if you are worried about hollow viscous perforation?

Intestines.

Be suspicious of areas of transition between rigidly fixed and mobile organs, e.g. small intestine around the ligament of Treitz and the transition of distal small bowel and right colon.

CT is a poor imaging modality for hollow viscous organ injury. You can only see secondary signs. Thus, the clinical picture is extremely important for the surgeons to decide whether to ex-lap or not.

References

-1- Tintinalli, Judith E., Gabor D. Kelen, and J. Stephan. Stapczynski. Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill, Medical Pub. Division, 2004. Print.

-2- Marx, John A., Robert S. Hockberger, Ron M. Walls, and James Adams.Rosen’s Emergency Medicine: Concepts and Clinical Practice. St. Louis: Mosby, 2002. Print.