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A ruptured spleen is an urgent medical condition that occurs when there is a break in the surface of the spleen. Located just beneath the rib cage on the left side, the spleen plays a crucial role in fighting infection and removing old blood cells from the bloodstream.
This condition is commonly caused by a strong impact to the abdomen, such as during sports accidents, physical altercations, or vehicular collisions. In individuals with an enlarged spleen, even a relatively mild trauma can lead to a rupture. If not promptly addressed, the internal bleeding resulting from a ruptured spleen can pose a severe risk to life.
Treatment for a ruptured spleen varies; some individuals may require immediate surgery, while others can recover with a few days of hospitalization.
Symptoms
Indicators and symptoms suggestive of a ruptured spleen comprise:
- Pain in the left shoulder.
- Blurring of vision.
- Being pale.
- Fainting.
- Distress in the upper left abdomen.
- Anxiety or being restless.
- Sensitivity to touch in the upper left abdomen.
- Feeling disoriented, faint, or lightheaded.
A ruptured spleen constitutes a medical emergency. If you experience signs and symptoms suggestive of a ruptured spleen following an injury, seek immediate emergency medical attention.
Causes
Causes of spleen rupture may include:
- Damage to the body’s left side. A ruptured spleen commonly occurs due to a forceful impact to the left upper abdomen or the left lower chest, which can happen during sporting accidents, fistfights, or car crashes. The spleen may rupture shortly after the abdominal trauma, or in certain instances, it may occur days or even weeks following the injury.
- Spleen enlargement. Enlargement of the spleen can result from the accumulation of blood cells within the organ. Various underlying issues can lead to an enlarged spleen, including conditions like mononucleosis, other infections, liver disease, and blood cancers.
Risk factors
An already enlarged spleen, whether from infection or another underlying condition, increases the likelihood of spleen rupture. Participating in contact sports involving chest impacts further raises this risk.
Diagnosis
Diagnostic methods for identifying a ruptured spleen encompass:
- A physical examination. To assess the size and tenderness of your spleen, your medical professional will apply pressure to your belly.
- Tests on blood. Tests on your blood will assess things like your platelet count and blood clotting ability.
- Examining your abdominal cavity for blood. In an emergency, your doctor may choose to take a sample of stomach fluid with a needle or use an ultrasound. Should the sample indicate that there is blood in your stomach, you may be recommended for urgent surgery.
- Diagnostic imaging of the stomach. In the event that your diagnosis remains unclear, your physician may suggest more imaging tests or a stomach computed tomography (CT) scan, maybe including contrast dye, to rule out other potential explanations for your symptoms.
Treatment
The approach to treating a ruptured spleen varies according to the severity of the condition. For critical injuries, immediate surgery is often necessary. However, many minor to moderate spleen injuries can heal without surgical intervention. If nonsurgical treatment is pursued, it typically involves hospitalization for close monitoring by the healthcare team, which may include the administration of blood transfusions as needed. Follow-up CT scans are common to assess the spleen’s healing progress and determine the necessity of surgery.
Surgical and non-surgical Interventions Include:
- Embolization: This procedure is particularly useful for managing grade III and IV spleen injuries, either as a preparatory step before surgery or as an alternative to it. Performed by an interventional radiologist, embolization involves using imaging technology to navigate a catheter into a blood vessel and release small, sponge-like particles to block blood flow and control bleeding.
- Splenorrhaphy: Often employed alongside arterial embolization for grade III or IV injuries, splenorrhaphy involves the surgical repair of the spleen. This may include suturing, using electrocautery to seal wounds, or applying hemostatic agents directly to the site of injury to stop bleeding. Successful splenorrhaphy can sometimes obviate the need for partial or total spleen removal.
- Spleen repair: Surgeons may use sutures or other methods to mend a ruptured spleen.
- Splenectomy: Complete removal of the spleen is sometimes necessary. Although individuals can live without a spleen, doing so increases their susceptibility to serious bacterial infections, such as sepsis. To mitigate this risk, vaccinations against diseases like meningitis, pneumonia, and Haemophilus influenzae type b (Hib) are often recommended, and in some cases, daily oral antibiotics might be prescribed as a preventive measure.
- Partial splenectomy: When feasible, only a portion of the spleen may be removed. This procedure aims to minimize the infection risks associated with total spleen removal.
Spleen surgery is generally regarded as safe, yet, like all surgical procedures, it carries potential risks, including bleeding, blood clots, infection, and pneumonia.
