The Ruptured spleen is a potentially life-threatening rupture of the spleen that can lead to profuse bleeding and is usually caused by 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 ruptured spleen?
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Humans are not necessarily dependent on the spleen. However, a so-called Ruptured spleen have life-threatening consequences in terms of a ruptured spleen. When the spleen ruptures, a tear forms in the connective tissue spleen capsule. Clinically, different degrees of severity of the disease are differentiated.
- The first degree of severity corresponds to an isolated capsular tear in the form of a subcapsular, non-expanding hematoma.
- Type 2 rupture of the spleen 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 spleen capsule and parenchyma, there is also bleeding of the segmental arteries.
- Type 4 consists of an injury to the capsule, the parenchyma and the segmental and hilar vessels, which is associated with a tear in the vascular peduncles.
- In the most severe form of spleen rupture, the spleen breaks apart, so to speak. The organ tears away from the splenic hilum and the vascular supply is completely interrupted.
The clinical symptoms of a ruptured spleen can be present in one or two stages. A single-stage rupture of the spleen leads to hemorrhagic hypovolemia immediately after the event of the tear. With a two-stage rupture, hypovolemia does not develop until several hours or even days after the event.
causes
In most cases, the rupture of the spleen occurs as part 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 traffic and sports accidents. If the patient is a multiple trauma patient, a ruptured spleen is often the most threatening of all trauma components.
In addition to blunt trauma, sharp trauma can also cause a rupture of the spleen, for example knife stab wounds or spikes in the ribs. Intraoperative injury is less commonly considered a traumatic cause of splenic rupture. In addition to the traumatic causes, a number of non-traumatic phenomena can cause the rupture of the spleen.
Such a connection is far less common than a rupture of the spleen after trauma. Nevertheless, there is the possibility of a rupture of the spleen in the context of viral infections such as EBV infection. The same goes for malaria. In individual cases, splenic tumors or lymphomas tear the spleen apart. Portal vein thrombosis is one of the possible causes of the rupture, but it is rare.
Symptoms, ailments & signs
The clinical symptoms of a ruptured spleen mainly depend on the severity of the underlying cause. The clinical picture can thus be characterized by significant differences from case to case. The spectrum of the injury begins with a slight bruising of the spleen, including water accumulation and the formation of edema, and can continue to a 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. Often a hematoma also forms.
If profuse bleeding occurs, hemorrhagic hypovolemic shock may result. Such a shock can usually be recognized by tachycardia and hypotension. Since the diaphragm and the phrenic nerve are sometimes irritated by a rupture of the spleen, pain in the area of the left side of the neck also occurs in the case of heavy bleeding or capsular hematomas, which are also known as Saegesser's signs.
Diagnosis & course of disease
In the case of a ruptured spleen, early diagnosis largely determines the patient's prognosis. In acute cases, the diagnosis can be made by means of abdominal sonography, as this enables the detection of free fluids in the area of the renal poles. If the sonographic findings are normal, although the patient continues to show symptoms of a rupture on palpation, the examination is repeated closely.
A two-stage rupture and the increase in any capsular hematomas cannot be overlooked in this way. An abdominal CT is always the safest diagnostic tool for a ruptured spleen. However, the patient's circulatory situation can prevent this imaging.
Complications
As a result of the ruptured spleen, most patients suffer from relatively severe pain in the lower part of the abdomen. These often spread to other regions of the body and lead to very unpleasant complaints 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 loss of consciousness.
The diagnosis of ruptured spleen is relatively easy and quick in most cases, so that early treatment can be initiated. In the worst case, in an acute emergency, the spleen has to be removed completely. Since the spleen is not a vital organ, the person affected can survive without a spleen.
However, those affected without a spleen are more prone to various infections and inflammations, which can lead to various complications or a reduced life expectancy. The rupture of the spleen can also be treated with medication and surgery. In most cases, there are no particular 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 quite possible. However, a rupture is still a clinical picture that must be treated with medication and medication. A said tear in the spleen is usually caused by external force. Since the spleen is responsible for filtering the blood, the cells there are abundantly filled with blood. If a rupture occurs, internal bleeding can occur, which must be stopped and stopped immediately. Otherwise there is a risk that the person concerned will bleed to death.
An abscess can even form if the wound in the spleen becomes infected. This leads to an uncomfortable feeling of tension because the pressure inside increases. In the event of such signs, the visit to the doctor should not be delayed. The following 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 the doctor. In the worst case, there is even a risk of life-threatening complications or permanent consequential damage that cannot be treated in retrospect.
Treatment & Therapy
Treatment of patients with ruptured spleen depends on the clinical severity of the individual. The therapy was primarily determined by the extent of bleeding and its hemodynamic relevance. If the capsule of the spleen is still intact, conservative therapy can often be used, depending on the extent of the bleeding. Fluid administration and blood transfusions improve the hemodynamic situation.
Patients on conservative therapy must be monitored closely. If the situation worsens, it is necessary to proceed invasively. This invasive procedure consists of an operation that aims to preserve the organ, especially in children or adolescents. Type 2 or 3 rupture of the spleen is treated surgically with local hemostasis measures, such as infrared coagulation, electrocoagulation or an intervention with fibrin glue.
As soon as the bleeding has stopped, a mesh compression can take place. The doctor usually uses an absorbable plastic mesh for this. If severity grade 4 or even 5 is present, the organ usually has to be removed in parts. In individual cases, a total splenectomy is required.
You can find your medication here
➔ Medicines for stomach ailments and painThe time of diagnosis has a major impact on the prognosis. If a rupture of the spleen is detected early, the prognosis is favorable. If a rupture of the spleen is discovered late, life-threatening consequences can occur. Not only the time of diagnosis, but also the age of the sick person should be considered when making a prognosis. Children who are often treated without surgery have a very good prognosis. The prognosis is worse in the elderly or sick.
If the spleen is partially removed, the person can lead a normal life. The reason for this is that the spleen grows back and therefore resumes its functions in full. Serious consequences, such as sepsis, rarely occur in people who have had their entire spleen removed. Sepsis is associated with high mortality.
On average, 80 out of 100 people are completely healed from a ruptured spleen. The chances of recovery are highest if the person concerned is treated within 72 hours. Physical rest until healing has a positive effect on the prognosis of the 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, follow-up care is aimed at strengthening the patient. After a surgical procedure to treat the ruptured spleen, a high level of hygienic standards must be adhered to to ensure that the spleen bed does not become infected with germs and become inflamed.
In the aftermath of the operation, those affected must therefore take it easy in order not to put any further strain on the weakened immune system. For these reasons, people with a ruptured spleen should be observed and monitored comprehensively in the hospital. This is the easiest way to identify possible complications so that early interventions can be made. In the event of insufficient control and care, the rupture of the spleen threatens numerous serious secondary diseases. Since treatment is protracted 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. Meditative relaxation exercises 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 make 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, during which the rupture is closed with a tissue adhesive - the patient should take care of himself. Depending on the size of the tear and the constitution after the operation, at least one to two weeks of bed rest apply. If the entire organ has been removed, a long-term break is necessary. An individual diet and moderate exercise will help you recover quickly and reduce the risk of complications.
A further rupture of the spleen can only be prevented to a limited extent. Attempts should be made to reduce the risk of abdominal trauma, for example by using better protective clothing during exercise. In addition, regular check-ups are indicated. The doctor must check the rupture or the site of the operation (if the spleen is removed) and ensure that the wound heals without complications. If a net was used to hold the parts of the spleen together, it must be checked regularly whether it has been properly absorbed by the body.
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