Ruptured spleen: Symptoms, treatment, and causes

The spleen is an organ located in the left-upper quarter of the abdomen, beneath the ribs. It is about the size of a clenched fist and plays a vital role in fighting infection and filtering blood. A spleen can split open, or rupture, during a traumatic injury.

This important organ has a number of functions, including the production of immune cells and antibodies. It is also responsible for removing abnormal or old blood cells and foreign bodies, such as bacteria and viruses, from the blood.

The spleen also recycles hemoglobin, the component in blood that carries oxygen, and stores platelets to help blood clot.

A tough, elastic outer layer containing muscle fibers covers the spleen. Blunt injury to the spleen can cause this layer to rupture.

Fast facts on ruptured spleen

The most common cause of splenic rupture is blunt trauma to the abdomen.

The spleen is the abdominal organ that is most at risk during blunt trauma injury.

Doctors diagnose a ruptured spleen by examining the abdomen and using either an ultrasound or CT scan, depending on the condition of the individual.

Surgery to remove the spleen is not always necessary. Observation and conservative treatment may be appropriate for some people.

Symptoms

Abdominal pain man
Pain in the upper abdomen can be a sign of a ruptured spleen.

The symptoms of a ruptured spleen are often accompanied by other signs of injury caused by blunt trauma to the abdomen.

Examples of these other injuries include rib fractures, pelvic fracture, and spinal cord injury.

The location of the spleen means that injury to this organ can cause pain in the upper-left part of the abdomen. However, after a rupture, pain can occur in other locations, such as the left chest wall and shoulder.

Pain felt in the left shoulder as a result of a ruptured spleen is known as Kehr’s sign. This feels worse when the individual breathes in. A ruptured spleen can cause pain in the left shoulder because bleeding from the spleen may irritate the phrenic nerve, a nerve that originates in the neck and extends through the diaphragm.

Abdominal tenderness is the most common sign of an injury inside the abdomen but is not specific to spleen injury.

Other symptoms include:

lightheadedness

confusion

blurred vision

fainting

signs of shock, including restlessness, anxiety, nausea, and paleness

These symptoms result from loss of blood and a drop in blood pressure.

Treatment

There are two main types of treatment for a ruptured spleen: Surgical intervention and observation.

Many people with a ruptured spleen experience serious bleeding that requires immediate surgery on the abdomen. The surgeon will cut open the abdomen and operate with a procedure called a laparotomy.

For people with less severe splenic rupture, doctors will often use observation instead of surgery. However, these individuals still require active treatment and usually need a blood transfusion.

People that have a low-grade splenic rupture and no signs of other injuries in the abdomen will generally be hemodynamically stable. This means that blood pressure will be close to normal.

Up until fairly recently, treatment for a spleen injury usually involved complete removal of the spleen, or splenectomy.

A non-operative approach to managing a splenic rupture is a modern development in adult trauma surgery and was adopted following its success in treating children without surgery. Trauma surgeons used to routinely remove spleens when there was evidence of splenic rupture.

Surgery is now avoided in 95 percent of children and 60 percent of adults that have a splenic rupture.

When surgery is performed, it is still common practice to remove the entire spleen, although less severe cases may allow a surgeon to repair a tear and put pressure on the spleen until the bleeding stops.

People who remain stable under observation will often undergo further scans for monitoring purposes, including CT scans.

Those in a stable condition may also undergo a procedure called splenic embolization. The procedure aims to stop any bleeding from the spleen. This procedure usually needs to be performed quickly and can help avoid the need to remove the spleen.

Splenic embolization requires specialized facilities and staff, including a vascular surgeon or interventional radiologist. They need to be experienced in carrying out a certain type of artery catheterization and in performing embolization techniques.

Surgical removal of the spleen

This is known as a splenectomy. It is normally performed during an emergency laparotomy on a person in an unstable condition.

In some cases of less severe spleen damage, the organ may be salvaged during surgery. Instead of being completely removed, it may be repaired with partial removal, patches, repairs, or staples. There are, however, very limited opportunities for these options.

Man pre-exercise drink
A person should not return to full-intensity exercise until around 3 months after treatment.

After a spleen is either repaired or removed, recovery can take a few weeks.

It is important for a person to rest and allow the body time to heal, and only to resume normal activity after receiving the go-ahead from their treating doctor. People who play sports are advised that they can resume mild physical exertion for three months before resuming their usual training or exercise regimen.

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