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

spleen The spleen (, from Ancient Greek '' σπλήν'', splḗn) is an organ (biology), organ found in almost all vertebrates. Similar in structure to a large lymph node, it acts primarily as a blood filter. The spleen plays important roles in reg ...

. The rupture of a normal spleen can be caused by trauma, such as a

traffic collision A traffic collision, also known as a motor vehicle collision, or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other moving or stationary obstruction, such as a tree, pole or building. Tr ...

Signs and symptoms

In minor injuries with little bleeding, there may be abdominal pain, tenderness in the

epigastrium In anatomy, the epigastrium (or epigastric region) is the upper central region of the abdomen. It is located between the costal margins and the subcostal plane. Pain may be referred to the epigastrium from damage to structures derived from the for ...

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 (circulatory), shock caused by severe hypovolemia (insufficient blood volume or extracellular fluid in the body). It can be caused by severe dehydration or blood loss. Hypovolemic shock is a medical emergency ...

are most prominent. This might include a rapid pulse, low blood pressure, rapid breathing, and paleness.

Causes

The most common cause of a ruptured spleen is blunt

abdominal trauma Abdominal trauma is an injury to the abdomen. Signs and symptoms include abdominal pain, tenderness (medicine), tenderness, rigidity, and bruise, bruising of the external abdomen. Complications may include blood loss and infection. Diagnosis ma ...

, 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 adu ...

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 mesotheli ...

. A diagnostic peritoneal lavage, 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 A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

. 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

AAST (American Association for the Surgery of Trauma) Organ Injury Scaling: Splenic Injury Grading Calculators have been developed that facilitate grading of splenic injury based on imaging findings.

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 seven days after the injury. Splenic artery embolization is a minimally invasive procedure and, where successful, avoids splenectomy. 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 adu ...

, most physicians will advise against activities (such as

contact sport A contact sport is any sport where physical contact between competitors, or their environment, is an integral part of the game. For example, gridiron football. Contact may come about as the result of intentional or incidental actions by the playe ...

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 tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

such as

pneumonia Pneumonia is an Inflammation, inflammatory condition of the lung primarily affecting the small air sacs known as Pulmonary alveolus, alveoli. Symptoms typically include some combination of Cough#Classification, productive or dry cough, ches ...

. 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)