What Is a Spleen Rupture?
Spleen rupture is an emergency medical condition occurring due to a break in the spleen's surface. If the spleen ruptures, it is most likely that all abdominal organs will have life-threatening internal bleeding. In the United States, approximately 40,000 people experience spleen injuries each year. Spleen rupture happens due to a forceful blow to the abdomen during an accident, fall, or fistfight. Even a less forceful trauma can rupture the spleen in people with an enlarged spleen. Emergency treatment is required for internal bleeding caused by a spleen rupture, or it can become life-threatening. Usually, emergency surgery treats spleen rupture; in less severe cases, hospitalization for several days will aid in the cure.
What Are the Causes of Spleen Rupture?
Several reasons can lead to a ruptured spleen. Blunt trauma to the abdomen, occurring due to accidents, is the most common cause of a ruptured spleen. Sports injuries like a strong football impact in the abdomen region and physical assault are other causes. It can also result from impalement, for example, stabbing from a knife wound.
Sometimes negligence during medical procedures can also cause a ruptured spleen. Spleen injury can commonly occur during abdominal surgery or endoscopic manipulation. It can cause a tear of the capsule of the spleen, tension in the spleen during colon manipulation, or laceration from retraction devices.
Rarely a splenic rupture can also occur without any injury. This kind of rupture occurs as a result of any disease to the spleen and is referred to as non-traumatic spleen rupture. However, a normal, healthy spleen can also rupture, although this is extremely rare.
Certain diseases and illnesses can also result in a spleen rupture. In such cases, the spleen becomes enlarged with the accumulation of blood cells, and the capsule-like covering becomes thin, making the spleen fragile and more likely to rupture even with the slightest trauma. Diseases that increase the risk of a ruptured spleen include:
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Infectious mononucleosis (a ruptured spleen can be the first sign of the illness in most cases).
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Hematological diseases such as certain types of lymphoma and hemolytic anemia.
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Infections like malaria.
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Cancer.
What Are the Symptoms of Spleen Rupture?
The most common symptom of spleen rupture is abdominal pain, and the exact location and severity of the pain depend on how badly the spleen has ruptured and the amount of internal bleeding. When rupture happens, the individual may experience distinct pain in that region due to the location of the spleen within the abdomen. In most cases, spleen rupture occurs due to abdominal trauma, for example, injuries caused due to pelvic fracture, rib fracture, spinal cord injury, etc. So, the patient may be unable to differentiate the pain caused by spleen rupture and injury to the abdomen.
After the rupture, the pain from a ruptured spleen can also be felt in the left side of the chest or the left shoulder, known as Kehr's sign. It happens due to the irritation to the left phrenic nerve that runs from the neck down through the left side of the chest. The pain will worsen when the patient breathes in.
Spleen rupture can cause abdominal bleeding that can drop the blood pressure level. The symptoms associated with blood pressure drops are:
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Lightheadedness.
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Blurred vision.
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Confusion.
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Fainting.
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Signs of shock include anxiety, paleness, restlessness, and nausea.
How Is an Injury to the Spleen Classified?
Splenic injury is classified based on several factors, including the severity of the injury, injury to the blood vessels, the level of laceration, and clotting. The grading for spleen injury given by the American Association for the Surgery of Trauma helps doctors to determine whether non-operative management or surgery is indicated for treatment.
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Grade 1: Capsule tear that goes less than 1 centimeter (cm) deep into the spleen, or hematoma (build-up of blood clot), under the capsule. The hematoma covers less than 10 % of the spleen's surface area.
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Grade 2: Capsule tear that goes 1 cm to 3 cm deep and does not involve the arterial branches of the spleen. Hematomas may cover 10 % to 50 % of the spleen's surface area. Hematoma is less than five centimeters in diameter into the spleen tissue.
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Grade 3: Capsule tear that goes more than 3 cm deep. The splenic artery may also be involved, and hematoma covers over half of the surface area.
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Grade 4: This grade lacerates the hilar or segmental blood vessels and depletes more than 25 % of the blood supply to the spleen.
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Grade 5: Severe tear that lacerates blood vessels and leads to total loss of blood supply to the spleen. In this stage, the hematoma can completely shatter the spleen.
How Is a Ruptured Spleen Diagnosed?
The diagnosis of spleen injury depends on the patient's condition; if the patient is stable, the healthcare team will ask about the patient's medical history, perform a physical exam, and feel the belly area. In a spleen injury, the abdominal area may look swollen and feel hard because of blood accumulation. This is followed by imaging tests like CT (computerized tomography) scan to get a better look at the spleen and the extent of the injury.
If the patient is unstable in the emergency room with a traumatic injury, the healthcare team will start with special bedside ultrasound (FAST ultrasound) to check for internal bleeding. If the ultrasound is positive and the vital signs are unstable, immediate treatment is required.
What Is the Treatment for Spleen Rupture?
Treatment for spleen rupture depends on the extent of the injury. The treatment options are several days of hospital care or surgery. Minor tears might stop bleeding, but other types of injury may require emergency repairs. In severe cases (grade V) of spleen ruptures, complete spleen removal, called splenectomy, is required. People with mild to moderate spleen injuries where surgery is not indicated still require several days of monitoring in the hospital, along with blood transfusions.
Surgery for small tears includes repairing the tear and putting pressure on the blood vessels or the spleen to stop bleeding. Another procedure, called arterial embolization, is a non-surgical procedure that should be performed immediately by an interventional radiologist. A guiding catheter is inserted into the blood vessel using radiology imaging techniques, and tiny, sponge-like beads are inserted into it to stop the blood flow.
Conclusion
Spleen rupture is a tear on the capsule of the spleen, causing severe bleeding. It usually occurs due to abdominal injury during an accident, fall, sports activities, or while performing a medical procedure, leading to severe abdominal pain and blood loss. Severe blood loss eventually results in low blood pressure and shock. So immediate treatment is required, or else it can be life-threatening. Treatment depends on the extent of the injury and the amount of blood loss. The treatment is mostly several days of intensive hospital care or surgery.
