What is a ruptured spleen? what causes a splenic rupture?

What is a ruptured spleen? what causes a splenic rupture?

The spleen is an organ of the immune system that plays an important role in filtering the blood and fighting infection. Given its position in the abdomen, it is particularly vulnerable to damage and may rupture if someone receives a hard and blunt blow to the abdomen, such as during a car crash.

A ruptured spleen is a medical emergency, but it can be challenging to diagnose as it can present in different ways. Treatment for damage to the spleen depends on the severity of the damage and the patient's condition.

Here are some key points about rupture of the spleen. More detail and supporting information is in the main article.

  • The most common cause of splenic rupture is blunt trauma injury to the abdomen.
  • The spleen is the abdominal organ most vulnerable to blunt trauma injury.
  • Splenic rupture is usually, but not always, very painful.
  • Pain may be felt in the spleen itself, although left-sided chest and shoulder pain are also common.
  • Doctors diagnose a ruptured spleen by examining the abdomen and using either ultrasound or a CT scan, depending on the patient's condition.
  • Internal bleeding that has made the patient's condition unstable necessitates urgent abdominal surgery to locate and address the source of the bleeding.
  • Surgery to remove the spleen (a splenectomy) is not always necessary; observation and conservative treatment may be appropriate for some patients.

What is the spleen?

The spleen is an abdominal organ, situated in the left upper quarter beneath the ribs, and is about the size of a cupped hand or clenched fist.1-2

The spleen has a number of important functions, including:1-5

  • Producing immune cells (lymphocytes) and antibodies
  • Removing foreign bodies from the blood circulation, including microorganisms such as bacteria and viruses
  • Removing abnormal and old red blood cells from the blood
  • Recycling hemoglobin, the oxygen-carrying protein in red blood cells
  • Storing blood platelets ready to help with clotting to stop severe bleeding
  • Forming the blood before birth (hematopoiesis), and helping to produce red blood cells after birth during times of anemic stress.

What is splenic rupture?

The spleen is encapsulated by a tough, elastic, outer layer that contains some muscle fibers.5 Blunt injury to the spleen can cause the capsule to split open - hence splenic rupture.

Splenic injury is classified by severity, including laceration, vascular injury and hematoma. The American Association for the Surgery of Trauma grading system for spleen injury is as follows:6,7

  • Grade 1: a tear (laceration) in the capsule that goes less than 1 cm deep into the spleen; or hematoma (accumulation of clotted blood) under the capsule over less than 10% of the spleen's surface area
  • Grade 2: a 1-3 cm tear that does not involve the trabecular vessels (splenic arterial branches); or hematoma under the capsule (subcapsular) over 10-50% of surface area; or intraparenchymal hematoma (inside the organ's tissue) less than 5 cm diameter
  • Grade 3: a tear with a depth greater than 3 cm or which involves the splenic artery; or subcapsular hematoma over 50% of the surface area; or an intraparenchymal hematoma greater than 5 cm or which is expanding
  • Grade 4: a tear that lacerates segmental or hilar blood vessels and causes loss of more than a quarter (25%) of the organ's blood supply
  • Grade 5: a hilar vascular injury with devascularized spleen, i.e. a tear that lacerates certain blood vessels and causes total loss of the organ's blood supply; or hematoma that completely shatters the spleen.

The grading of a splenic rupture helps doctors to determine whether surgical or non-operative management is indicated for treatment.

Causes of a ruptured spleen

The most common cause of a ruptured spleen is blunt trauma to the abdomen, usually as a result of a road traffic collision (as a driver, passenger or pedestrian), but also resulting from sports injuries and physical assault.1,8,9

The spleen is the most likely of the abdominal organs to suffer an injury during physical trauma.1

Automotive accidents are the most common cause of splenic rupture. The spleen is the organ in the abdomen most vulnerable to blunt injury.

In addition to blunt trauma, some cases of rupture result from impalement, such as from a knife wound; the location of the spleen under the ribs means that it is, however, somewhat protected against this type of penetrating trauma.1

Medical interventions can sometimes cause unintended complications, including splenic rupture. This type of harm, occurring in the course of medical intervention, is known as iatrogenesis. Iatrogenic injury to the spleen is most commonly caused by abdominal surgery or endoscopic manipulation, and can take any of these forms:1

  • Tear of the capsule of the spleen
  • Laceration from the use of retraction devices
  • Tension on the spleen during colon manipulation.

In rare cases, a splenic rupture is not caused by an injury. This type of splenic rupture is known as non-traumatic rupture and usually results from a disease of the spleen. In exceptionally rare cases, it can occur spontaneously in the normal spleen.9

Causes of splenic disease that can potentially lead to rupture include:9

  • Infection, including malaria
  • Cancer malignancy
  • Metabolic disorders
  • Vascular and hematological diseases.

Symptoms of a ruptured spleen

The symptoms of a ruptured spleen are often accompanied by other signs and symptoms of injury caused by blunt trauma to the abdomen, as this is the most common reason for splenic rupture. Examples of these other injuries include rib fractures, pelvic fracture, and spinal cord injury.1

The location of the spleen means that injury to this organ may cause pain in the upper left of the abdomen.1,10 However, splenic rupture can cause pain in other locations, such as the:1

  • Left chest wall
  • Left shoulder.

Pain felt in the left shoulder as a result of splenic rupture is referred to as Kehr's sign - this is referred pain that feels worse when then patient breathes in. The reason why a ruptured spleen can cause pain in the left shoulder is that bleeding from the spleen may cause irritation of the phrenic nerve, a nerve that originates in the neck and innervates the diaphragm.1

Abdominal tenderness is the most common sign of injury inside the abdomen but is not specific to splenic injury. An abdominal examination may also be unremarkable in some cases of splenic rupture, further underlining the need for rigorous diagnostic investigation.1

Signs and symptoms that are secondary to splenic rupture, resulting from loss of blood and a drop in blood pressure, include:10

  • Light-headedness
  • Confusion
  • Blurred vision
  • Fainting
  • Signs of shock, including restlessness, anxiety, nausea and paleness.

On the next page, we look at tests and diagnosis of a ruptured spleen and the available treatment options for the condition.

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Symptoms Of A Ruptured Spleen (Video Medical And Professional 2020).

Section Issues On Medicine: Medical practice