Splenic rupture is a potentially life-threatening rupture of the spleen that can cause profuse bleeding and usually results from blunt abdominal trauma. The different degrees of severity of the ruptured spleen are treated differently. In the most severe degree of rupture, the spleen is surgically removed.
What is a rupture of the spleen?
Man is not necessarily dependent on the spleen. However, a so-called spleen rupture in the sense of a rupture of the spleen can have life-threatening consequences. When the spleen ruptures, a tear forms in the connective tissue capsule of the spleen. Clinically, different degrees of severity of the disease are distinguished. See AbbreviationFinder for abbreviations related to Rupture of the Spleen.
- The first grade of severity corresponds to an isolated capsular rupture in the form of a subcapsular, non-expanding hematoma.
- Type 2 splenic rupture is an injury to the capsule and parenchyma. The splenic hilum and segmental arteries are not injured.
- In type 3, in addition to injuries to the splenic capsule and the parenchyma, there is also bleeding in the segmental arteries.
- Type 4 consists of injury to the capsule, parenchyma, and segmental and hilar vessels associated with avulsion of the vascular pedicles.
- In the most severe form of splenic rupture, the spleen breaks apart, so to speak. The organ tears out of the hilum of the spleen and the vascular supply is completely interrupted.
The clinical symptoms of a splenic rupture can be one-stage or two-stage. A single stage rupture of the spleen leads to hemorrhagic hypovolemia immediately after the event of the rupture. In a two-stage rupture, hypovolemia does not develop until several hours or even days after the event.
Causes
The rupture of the spleen takes place in most cases in the context of an accident and then has a traumatic cause. In this context, the rupture of the spleen is considered to be a consequence of blunt abdominal trauma, which is often associated with accidents at work, but also with traffic accidents and sports accidents. When the patient is a polytrauma patient, a ruptured spleen is often the most threatening of all trauma components.
Under certain circumstances, in addition to blunt trauma, sharp trauma can also cause a rupture of the spleen, such as knife wounds or rib impalings. An intraoperative injury is less commonly considered a traumatic cause for the rupture of the spleen. In addition to the traumatic causes, a number of non-traumatic phenomena can cause the spleen to rupture.
Such a connection is considered to be far less common than a ruptured spleen after trauma. Nevertheless, in the context of viral infections such as EBV infection, there is a possibility of rupture of the spleen. The same applies to malaria. In isolated cases, spleen tumors or lymphomas tear the spleen apart. Portal vein thrombosis is also one of the conceivable causes of the rupture, but is rather rare.
Symptoms, Ailments & Signs
The clinical symptoms of a rupture of the spleen depend primarily on the severity of the triggering cause. The clinical picture can be characterized by significant differences from case to case. The spectrum of injury begins with mild splenic contusion, including fluid retention and edema, and can progress to complete rupture of the spleen with significant hemorrhage within the abdominal cavity.
Patients with a ruptured spleen almost always complain of more or less severe abdominal pain, which is primarily located in the upper left quadrant and often radiates into the left arm. In the upper left quadrant of the abdomen, patients are sensitive to pressure and have a defensive tension. A hematoma often forms as well.
If profuse bleeding occurs, hemorrhagic hypovolemic shock may occur. Such a shock is usually recognized by tachycardia and hypotension. Since the diaphragm and the phrenic nerve are sometimes also irritated by a rupture of the spleen, severe bleeding or capsule hematomas also cause pain in the area of the left side of the neck, which is also known as the Saegesser sign.
Diagnosis & disease progression
In the case of a ruptured spleen, the timely diagnosis essentially determines the prognosis of the patient. In acute cases, the diagnosis can be made by means of abdominal sonography, as this can provide evidence of free fluids in the area of the kidney poles. If the sonographic findings are unremarkable, although the patient still shows the symptoms of a rupture on palpation, the examination is repeated frequently.
A two-stage rupture and the increase in any capsule hematomas cannot be overlooked in this way. An abdominal CT is always the most reliable diagnostic tool for a splenic rupture. However, the patient’s circulatory situation may prevent this imaging from being performed.
Complications
Due to the rupture of the spleen, most patients suffer from relatively severe pain in the lower area of the abdomen. These often spread to other regions of the body and lead to very unpleasant symptoms all over the body. It is not uncommon for the arms to be affected by the pain. In some cases, the pain can also lead to a loss of consciousness.
In most cases, the diagnosis of a ruptured spleen is relatively simple and quick, so that early treatment can be initiated. In an acute emergency, the spleen must be completely removed in the worst case. Since the spleen is not a vital organ, the affected person can survive without a spleen.
However, without a spleen, the affected person is more susceptible to various infections and inflammations, which can lead to various complications or a reduced life expectancy. A ruptured spleen can also be treated with medication and surgery. Usually there are no special complications. Whether the treatment or the removal of the spleen will result in a reduced life expectancy cannot be predicted.
When should you go to the doctor?
The spleen is not a vital organ, so life without a spleen is entirely possible. However, a rupture is still a clinical picture that must be treated medically and with medication. Said rupture in the spleen is usually caused by external violence. Since the spleen is responsible for filtering the blood, the cells there are richly filled with blood. If a tear occurs, internal bleeding can occur, which must be stopped and staunched immediately. Otherwise there is a risk that the affected person will bleed to death.
Even the formation of an abscess is possible if the wound becomes infected in the spleen. This leads to an uncomfortable feeling of tension because the pressure inside increases. With such signs, the visit to the doctor should not be delayed. The following therefore applies: A ruptured spleen should generally always be treated medically and with medication. Otherwise there is a risk of serious and dangerous complications that can be avoided by visiting a doctor. In the worst case, there is even a risk of life-threatening complications or permanent consequential damage that cannot be treated afterwards.
Treatment & Therapy
Treatment of patients with ruptured spleen depends on the clinical severity of the individual case. Above all, the extent of bleeding and its hemodynamic relevance determined the therapy. If the capsule of the spleen is still intact, conservative therapy can often be given, depending on the extent of the bleeding. Fluid administration and blood transfusions improve the hemodynamic situation.
Patients on conservative therapy must be closely monitored. If the situation worsens, an invasive approach must be taken. This invasive procedure consists of an operation aimed at preserving the organ, especially in children or adolescents. Type 2 or 3 spleen ruptures are treated surgically with local measures to stop bleeding, such as infrared coagulation, electrocoagulation, or intervention with fibrin glue.
Once hemostasis has occurred, mesh compression can take place. The doctor usually uses an absorbable plastic mesh for this purpose. If the severity is 4 or even 5, the organ usually has to be removed in parts. In some cases, a total splenectomy is required.
The time of diagnosis has a major impact on the prognosis. If a ruptured spleen is detected early, the prognosis is good. If a rupture of the spleen is discovered late, it can have life-threatening consequences. Not only the time of diagnosis, but also the age of the patient must be considered in a prognosis. Children who can often be treated without surgery have a very good prognosis. The prognosis is poorer in older people or those who are ill.
If the spleen is partially removed, the affected person can lead a normal life. The reason for this is that the spleen grows back and therefore resumes its full range of functions. Serious consequences, such as sepsis, rarely occur in people who have their entire spleen removed. Sepsis is associated with a high mortality rate.
On average, 80 out of 100 people recover completely from a ruptured spleen. The prospect of a cure is highest if the affected person is treated within 72 hours. Resting your body until it heals also has a positive effect on the prognosis of a ruptured spleen. Healing is usually achieved within two to three months.
Prevention
A rupture of the spleen can only be prevented to the extent that blunt abdominal trauma can be prevented.
Aftercare
A ruptured spleen is a medical emergency and requires immediate medical attention. If the life-threatening condition has been overcome, the follow-up care is aimed at strengthening the patient. After an operation to treat the rupture of the spleen, a high standard of hygiene must be maintained to ensure that the spleen bed does not become infected with germs and become inflamed.
In the aftermath of the operation, those affected must take it easy so as not to further burden the weakened immune system. For these reasons, people with a ruptured spleen must be observed and monitored extensively in hospital. This is the best way to identify possible complications, so that early intervention can take place. If there is insufficient control and care, the rupture of the spleen can lead to numerous serious secondary diseases. Since the treatment is still lengthy even after the acute phase, those affected should try to develop a positive attitude towards the situation in order to make it easier to deal with the disease. Here, meditative relaxation practices can help calm the mind and focus on recovery.
You can do that yourself
A ruptured spleen requires medical evaluation and treatment. Medical therapy can, however, be supported by various measures.
First and foremost, it is important to arrange an appointment for the operation as soon as possible in order to avoid further damage. After an operation – usually a so-called laparoscopy is performed, in which the rupture is closed with a tissue adhesive – the patient should take it easy. Depending on the size of the tear and the constitution after the procedure, bed rest is recommended for at least one to two weeks. If the entire organ has been removed, a long-term break is necessary. An individual diet and moderate exercise contribute to a speedy recovery and reduce the risk of complications.
Another rupture of the spleen can only be prevented to a limited extent. An attempt should be made to reduce the risk of abdominal trauma, for example by paying attention to better protective clothing during sports. In addition, regular check-ups are indicated. The doctor must monitor the rupture or the site of the procedure (if the spleen is removed) and ensure that the wound heals without complications. If a mesh has been used to hold the spleen together, it must be checked regularly that it has been properly absorbed by the body.
