A splenic injury, which includes a ruptured spleen, is any injury to the

spleen The spleen is an organ found in almost all vertebrates. Similar in structure to a large lymph node, it acts primarily as a blood filter. The word spleen comes .

. The rupture of a normal spleen can be caused by

trauma Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...

, such as a traffic collision.

Signs and symptoms

In minor injuries with little bleeding, there may be abdominal pain, tenderness in the epigastrium and pain in the left flank. Often there is a sharp pain in the left shoulder, known as Kehr's sign. In larger injuries with more extensive bleeding, signs of

hypovolemic shock Hypovolemic shock is a form of shock caused by severe hypovolemia (insufficient blood volume or extracellular fluid in the body). It could be the result of severe dehydration through a variety of mechanisms or blood loss. Hypovolemic shock is a ...

are most prominent. This might include a rapid pulse,

low blood pressure Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the di ...

rapid breathing Tachypnea, also spelt tachypnoea, is a respiratory rate greater than normal, resulting in abnormally rapid and shallow breathing. In adult humans at rest, any respiratory rate of 1220 per minute is considered clinically normal, with tachypnea b ...

, paleness, and anxiety.

Causes

The most common cause of a ruptured spleen is blunt abdominal trauma, such as in traffic collisions or sports accidents. Direct, penetrating injuries, for example, stab or gunshot wounds are rare. Non-traumatic causes are less common. These include infectious diseases, medical procedures such as colonoscopy, haematological diseases, medications, and pregnancy. In less than one percent of cases of

infectious mononucleosis Infectious mononucleosis (IM, mono), also known as glandular fever, is an infection usually caused by the Epstein–Barr virus (EBV). Most people are infected by the virus as children, when the disease produces few or no symptoms. In young adult ...

splenic rupture may occur.

Diagnosis

Milzruptur - Computertomographie axial - pv-Kontrastphase 001

Splenic rupture is usually evaluated by FAST ultrasound of the abdomen.Mattox 2012, p. 566 Generally this is not specific to splenic injury; however, it is useful to determine the presence of free floating blood in the

peritoneum The peritoneum is the serous membrane forming the lining of the abdominal cavity or coelom in amniotes and some invertebrates, such as annelids. It covers most of the intra-abdominal (or coelomic) organs, and is composed of a layer of mes ...

. A

diagnostic peritoneal lavage Diagnostic peritoneal lavage (DPL) or diagnostic peritoneal aspiration (DPA) is a surgical diagnostic procedure to determine if there is free floating fluid (most often blood) in the abdominal cavity. Indications This procedure is performed when i ...

, while not ideal, may be used to evaluate the presence of internal bleeding a person who is hemodynamically unstable.Trunkey 2008, p. 401 The FAST exam typically serves to evaluate the need to perform a CT scan. Computed tomography with IV contrast is the preferred imaging study as it can provide high quality images of the full peritoneal cavity.

Organ injury scale

American Association for the Surgery of Trauma Organ Injury Scaling: Splenic Injury Grading

Treatment

Because a splenic rupture permits large amounts of blood to leak into the abdominal cavity, it can result in shock and death. Generally a nonoperative approach is chosen in those who are hemodynamically stable with non-worsening symptoms. During this period of nonoperative management strict bed rest between 24 and 72 hours with careful monitoring along with a CT 7 days after the injury. If an individual's spleen is enlarged, as is frequent in

mononucleosis Infectious mononucleosis (IM, mono), also known as glandular fever, is an infection usually caused by the Epstein–Barr virus (EBV). Most people are infected by the virus as children, when the disease produces few or no symptoms. In young adult ...

, most physicians will advise against activities (such as

contact sport Contact sports are sports that emphasize or require physical contact between players. Some sports, such as mixed martial arts, are scored on impacting an opponent, while others, including rugby football, gridiron football and Australian rules f ...

s) where injury to the abdomen could be catastrophic. Patients whose spleens have been removed via a

splenectomy A splenectomy is the surgical procedure that partially or completely removes the spleen. The spleen is an important organ in regard to immunological function due to its ability to efficiently destroy encapsulated bacteria. Therefore, removal of ...

must receive immunizations to help prevent

infections An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...

such as

pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severit ...

. This helps to replace the lost function of this organ.

References

Bibliography

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External links

{{DEFAULTSORT:Ruptured Spleen Injuries of abdomen, lower back, lumbar spine and pelvis Spleen (anatomy)