Ruptured Spleen

The spleen is a delicate, fist-sized organ under your left rib cage near your stomach. It contains special white blood cells that destroy bacteria and help your body fight infections. The spleen also makes red blood cells and helps remove, or filter, old ones from the body's circulation.

A layer of tissue entirely covers the spleen in a capsule-like fashion, except where veins and arteries enter the organ. This tissue, called the splenic capsule, helps protect the spleen from direct injury.

What Is a Ruptured Spleen?

A ruptured spleen is an emergency medical condition that occurs when the capsule-like covering of the spleen breaks open, pouring blood into your abdominal area. Depending on the size of the rupture, a large amount of internal bleeding can occur.

Your doctor may refer to a ruptured spleen as a "splenic rupture."

What Causes a Ruptured Spleen?

The spleen can rupture when the abdomen suffers a severe direct blow or blunt trauma. The spleen is the most frequent organ to be damaged in blunt trauma injuries involving the abdomen. That's true regardless of your age.

The following are among the frequent causes of spleen injuries:

• Motor vehicle accidents
• Injury during contact sports, such as football and hockey
• Bicycle accidents, such as falling into your bicycle's handlebars
• Domestic violence

Certain diseases and illnesses can also lead to a ruptured spleen. In such cases, the spleen becomes swollen and the capsule-like covering becomes thin. This makes the organ especially fragile and more likely to rupture if the abdomen receives a direct hit.

Diseases that increase the risk for a ruptured spleen include:

• Infectious mononucleosis. In some cases, a ruptured spleen is the first sign of the illness.
• Blood (hematological) diseases such as hemolytic anemia and certain types of lymphoma
• Malaria

Symptoms of a Ruptured Spleen

A ruptured spleen causes abdominal pain, usually severe, but not always. The severity and even the location of the pain depend on how badly the spleen has ruptured and how much blood leaks out. Pain may be felt in these locations:

• Left side of the abdomen under the rib cage
• Left shoulder, because nerves of the left shoulder and left side of the diaphragm originate from the same location and the rupture may irritate these nerves

Internal bleeding caused by the ruptured spleen can cause blood pressure to drop. This can cause:

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

How Is a Ruptured Spleen Diagnosed?

The doctor will do a physical exam and ask about the patient's medical history and feel their belly area. The abdominal area may feel hard and look swollen (distended) because it has filled with blood. If there has been a great deal of blood loss from the spleen, the patient may have low blood pressure and a rapid heart rate. Sudden low blood pressure in someone who is believed to have a spleen injury, particularly a young person, is a sign that the condition is especially severe, and emergency surgery is needed.

How Is a Ruptured Spleen Diagnosed?

Imaging tests are needed to diagnose a ruptured spleen. A computed tomography (CT) scan of the abdomen is one of the most common methods used. During the test, a special substance, called contrast, is injected into a vein, usually in the arm. The contrast helps the doctor determine the amount of bleeding from the spleen. Active bleeding from the spleen may not be seen on the CT scan without contrast.

However, a CT scan of the abdomen may only be done if time allows. A CT scan with contrast may take awhile, and some people with spleen ruptures have died while waiting to have the test done. For this reason, a CT scan is not recommended for those with a spleen rupture who have unstable vital signs or low blood pressure due to the injury (suggesting shock). They would have a quick ultrasound, and then go straight to surgery if bleeding is detected.

Other people are allergic to CT contrast or cannot receive it because their kidneys do not work properly.

In these cases, other tests may be used to help diagnose a spleen rupture. They include:

Focused abdominal sonographic technique (FAST). This is an ultrasound method to check for blood in the abdominal area. It can be used to help diagnose a ruptured spleen in unstable patients, but studies have found CT to be better in an emergency setting.

Diagnostic peritoneal lavage. This is a method to rapidly determine if blood is gathering in the abdominal area. It is fast and inexpensive, and can be done on spleen rupture patients who have low blood pressure.

MRIof the abdomen. This may be an option for stable patients with kidney failure or who have severe allergies to the contrast substance used during a CT scan.

If the person is stable and does not need emergency surgery, laboratory tests such as a complete blood count (CBC) or hemoglobin level may be done at routine intervals to check for blood loss.

How Is a Ruptured Spleen Treated?

In the past, treatment for a spleen injury always meant removal of the entire organ, called a splenectomy. However, doctors now say that some spleen injuries can heal on their own, particularly those that are not very severe. People with spleen injuries who do not need surgery must still be monitored in a hospital, and they may need blood transfusions.

Immediate, emergency surgery to remove or repair the spleen is done in the following cases:

• If the doctor thinks there is massive internal bleeding
• If a person with a suspected spleen rupture has low blood pressure or unstable vital signs

When surgery is done, the entire spleen is still usually removed. But in the case of small tears, the surgeon may try to save the spleen instead. This involves repairing the tear and putting pressure on the spleen or blood vessels till the blood clots and stops the leak. Another procedure, called arterial embolization, may be a safe way to save the spleen, but only if it can be done immediately.

What to Expect After a Ruptured Spleen

Recovery depends on the severity of the rupture. In general, the outcome is excellent for those with more mild spleen ruptures (grade I and II injuries). The more severe the spleen injury, the more guarded the outcome. The risk of complications appears to be greatest in people over age 55.

Deaths caused by splenic rupture are possible and do still occur, even at the top trauma centers.

You can live without a spleen. However, since the spleen plays a crucial role in the body's ability to fight certain bacteria, living without the organ puts you at higher risk for life-threatening infections. Everyone should receive the vaccine for pneumococcus, and some should get vaccines for meningococcus and haemophilus influenzae type b. These vaccines usually are given 14 days prior to an elective splenectomy or 14 days after the surgery.

Children who have their spleen removed may need to take antibiotics every day to prevent them from getting sick. Adults usually do not need daily antibiotics unless they become sick or there is a chance they could become sick. Regardless of age, if you have had your spleen removed it's a good idea to wear a medical alert bracelet.

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