An Overview of Ruptured Spleen

Symptoms, Causes, Diagnosis, and Treatment

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Human spleen, illustration
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The spleen is a small organ located in the upper left quadrant of the abdomen under the ribcage (well above and far left of the belly button). If you could see the spleen, it looks purple and squishy. It's considered a solid organ, meaning it's not hollow like a bladder or a stomach. Its consistency is more like a small version of the liver. The full function of the spleen is still under debate, but we do know it plays a major role in the immune system.

Half of the spleen tissue is called the red pulp and is responsible for filtering out old and damaged red blood cells, and acts as a reservoir for platelets and red blood cells. The other tissue is the white pulp, which produces antibodies and is connected to the lymphatic system.

A ruptured spleen refers to bleeding into the abdominal cavity from a torn or lacerated spleen. Most spleen damage is due to traumatic injury, but it can occur spontaneously if the spleen is inflamed or diseased.

All of the circulation of blood and lymph through the spleen makes it a prime candidate for bleeding if injured. Of patients with traumatic injuries to multiple body systems, 10 to 12 percent have abdominal trauma. The liver and spleen are the two most commonly injured abdominal organs. Considering trauma is the fourth leading cause of death, that indicates a lot of ruptured spleens and livers.

Symptoms

In a trauma patient with injury to the abdomen, the most common symptoms of a ruptured spleen are pain and tenderness of the abdomen, particularly on the left upper quadrant. As blood enters the abdominal cavity, it can lead to a symptom known as referred pain. This is pain that the patient feels somewhere other than where the injury is located.

In the case of a ruptured spleen, the most common referred pain is felt in the left shoulder or left side of the chest wall.

Since the spleen is so rich with blood flow, bleeding from a rupture can be significant. If left untreated, bleeding from a ruptured spleen can very quickly lead to hypovolemia (when plasma portion of the blood is too low) and shock (a medical condition that decreases blood flow to the brain).

As the circulatory system struggles to get blood to important areas such as the brain, the patient can experience sweating, lightheadedness, fatigue, confusion, and eventually unconsciousness.

Causes

The most common cause of a ruptured spleen is blunt trauma to the abdomen, such as that experienced in a car crash or a fall from a significant height. Blunt trauma is the type of trauma that does not directly penetrate the skin, like a stabbing or gunshot wound. Penetrating trauma is less common, but can also lead to a ruptured spleen.

In rare cases, a ruptured spleen can occur spontaneously without trauma. The spleen can become inflamed and enlarged from infection, cancer, or other diseases. The disease that is most often associated with a non-traumatic ruptured spleen is mononucleosis, even though the incidence of a ruptured spleen is only .1 percent of all cases of mononucleosis.

Malaria is another infectious disease associated with ruptured spleen. Other than the lack of a trauma history, the symptoms of a spontaneously ruptured spleen are similar to those caused by injury.

Diagnosis

A strong clinical assessment with a focused history, a mechanism of injury, and physical exam may provide a high index of suspicion for diagnosis, but a ruptured spleen can't always be ruled out from just a clinical assessment. Ultrasound is an option but still cannot rule out a ruptured spleen adequately.

If available, a CT scan is the best option for evaluating the abdomen and diagnosing a ruptured spleen. CT scans can detect as little as 100 cubic centimeters of blood in the abdomen, an amount similar to about one-third of a can of soda.

Treatment

Non-surgical management of ruptured spleen is the primary option for treatment as long as the patient's blood pressure is stable and there is not severe bleeding. Close monitoring, bed rest, and blood pressure control are used to give the spleen time to heal. For patients that come to the hospital with stable blood pressures, non-surgical treatment is very successful.

Some hospitals may try interventional radiological treatment for ruptured spleens. This is a relatively recent option and is not always available.

Depending on the severity of the ruptured spleen and how stable the blood pressure is, the patient may have to have surgery. The surgeon will focus on repairing the spleen if possible, however part or all of the spleen may have to be removed (called a splenectomy). If the spleen is removed, the patient may have to take a series of vaccinations to boost immune function after surgery.

A Word From Verywell

A ruptured spleen is a serious condition whether it comes from trauma or not. If you have left shoulder pain following an injury to the abdomen—especially if there wasn't any trauma to the shoulder—be sure to seek emergency medical care. And if there's no trauma at all, you should always see a doctor for chest pain or left shoulder pain.

The most important treatment for a ruptured spleen is an early diagnosis. Whether the ruptured spleen is going to be treated with or without surgery, the earlier that decision can be made the better.

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