In people who are hemodynamically stable, a CT scan is typically used to help determine the grade of injury. In the emergency trauma setting, an ultrasound scan is performed while other monitoring and management continue uninterrupted. This scan is done according to the focused assessment with sonography for trauma FAST protocol, which forms part of the advanced trauma life support ATLS protocol developed by the American College of Surgeons.
A FAST ultrasound enables clinicians to scan for fluid in four areas of the abdomen, including the space around the spleen. The doctor draws fluid from the abdominal cavity.
Nowadays, this is rarely performed. A ruptured spleen is often identified by a CT scan. In some cases, such as where a patient has kidney stones or is allergic to the contrast substance used in a CT scan, a stable individual with a suspected ruptured spleen may undergo an MRI scan.
This can also show problems with the soft tissues of the body. Splenic injury is classified by severity, taking into account the level of laceration, injury to the veins and arteries, and clotting. The American Association for the Surgery of Trauma grading system for spleen injury is as follows:. The grading of a ruptured spleen helps doctors determine whether surgical or non-operative management is indicated for treatment. Gaucher's disease is a inherited disease that results in a build up of lipids.
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In this article, we discuss the spleen. We will explain what the spleen does, the types of cells involved, and what happens when it goes wrong. What are the different types of bleeding, and how can a person treat them?
Read on to learn more. Everything you need to know about ruptured spleen. Medically reviewed by Andrew Gonzalez, M. Symptoms Treatment Recovery Complications Causes Diagnosis Stages The spleen is an organ located in the left-upper quarter of the abdomen, beneath the ribs.
Share on Pinterest Pain in the upper abdomen can be a sign of a ruptured spleen. Share on Pinterest A person should not return to full-intensity exercise until around 3 months after treatment. Share on Pinterest A doctor will examine the abdomen by applying pressure to certain areas. Adolescent depression: Could school screening help? Related Coverage. Gaucher's disease: What you need to know. Medically reviewed by University of Illinois. Causes and treatments of aneurysm.
Medically reviewed by Seunggu Han, MD. The pain was associated with nausea but no vomiting. He denied any history of trauma, change in bowel habit or urinary symptoms.
He reported 2 episodes of a similar, but much less severe, pain in the preceding week. There was no significant past medical history and he was not on any regular medications. Chest examination was unremarkable. Abdominal examination showed left-sided tenderness. PR examination was unremarkable. Following initial successful fluid resuscitation, he underwent a CT scan which showed free fluid in the abdomen and a perisplenic haematoma with disruption of the splenic parenchyma Figure 1.
Initial bloods were unremarkable but repeat bloods after 6 hours showed Hb 7. Coronal section of the Abdominal CT scan shows free fluid in the abdomen and a splenic haematoma. The splenic injury was initially managed conservatively, including transfusion of 3 units of red blood cells. On re-assessment the abdomen remained tender on the left. As the patient remained haemodynamically unstable, the decision was made to proceed to a splenectomy. At laparotomy the patient had approximately 2 litres of haemolysed blood in the abdominal cavity and a large perisplenic haematoma with grade IV splenic injury i.
He was transfused an additional 2 units intra-operatively. Histopathology showed normal splenic tissue and no other underlying pathology. Post-operatively, the patient received pneumococcal, meningococcal and haemophilus vaccinations and was discharged on life-long penicillin prophylaxis. Atraumatic splenic rupture was first documented in the 19 th century. Since then it has been associated with several underlying pathologies, including infectious e. In the absence of trauma, diagnosis of splenic rupture is not always made by considering just the classic signs and symptoms of left upper quadrant LUQ pain, guarding and haemodynamic instability [ 3 ].
As in the case presented, the atraumatic history and absence of underlying pathologies meant that only the symptoms of left-sided abdominal pain not specifically LUQ pain and sudden haemodynamic instability raised the suspicion of splenic rupture. Clinicians should have a high index of suspicion in diagnosing atraumatic splenic rupture; particularly in a patient with isolated left-sided abdominal pain.
Other differentials in such a patient would include cardiac ischaemia, pulmonary embolism, pneumonia, peptic ulceration or ruptured sigmoid diverticulitis [ 6 , 7 ]. A CT scan is often essential to make the diagnosis and grade the splenic injury, although an ultrasound scan may be clinically useful.
The most common finding on CT is splenomegaly with splenic lacerations and intraperitoneal or subcapsular bleeding [ 6 ]. We use a grading system of I—V based on CT findings.
This scale considers the size of the splenic laceration and associated haematoma as well as any hilar involvement [ 8 ]. There is however, evidence that the clinical situation should be the most important factor in guiding management decisions [ 8 ]. Even patients with high-grade splenic injuries may be managed conservatively if they are haemodynamically stable.
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.
In a trauma patient with an 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. 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 often associated with a non-traumatic ruptured spleen is mononucleosis, even though the incidence of a ruptured spleen occurs in an estimated. Malaria is another infectious disease associated with a ruptured spleen.
Other than the lack of a trauma history, the symptoms of a spontaneously ruptured spleen are similar to those caused by injury. 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 in a clinically stable patient. Non-surgical management of a 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.
If the spleen is removed, the patient may have to take a series of vaccinations to boost immune function after surgery. 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.
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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