Splenic injury

A splenic injury, which includes a ruptured spleen,

Splenic injury
is any injury to the spleen. The rupture of a normal
spleen can be caused by trauma, such as a traffic
collision.

Contents
Signs and symptoms
Causes
Diagnosis
Organ injury scale
Treatment Spleen ruptured by trauma
See also Specialty Emergency medicine 
References
Bibliography
External links

Signs and symptoms

In minor injuries with little bleeding, there may be abdominal pain, tenderness in the epigastrium and pain
in the left flank. Often there is a sharp pain in the left shoulder, known as Kehr's sign. In larger injuries with
more extensive bleeding, signs of hypovolemic shock are most prominent. This might include a rapid pulse,
low blood pressure, rapid breathing, paleness, and anxiety.

Causes
The most common cause of a ruptured spleen is blunt abdominal trauma, such as in traffic collisions or
sports accidents. Direct, penetrating injuries, for example, stab or gunshot wounds are rare.

Non-traumatic causes are less common. These include infectious diseases, medical procedures such as
colonoscopy, haematological diseases, medications, and pregnancy.[1]

In less than one percent of cases of infectious mononucleosis splenic rupture may occur.[2]

Diagnosis
Splenic rupture is usually evaluated by FAST ultrasound of the abdomen.[3] Generally this is not specific to
splenic injury; however, it is useful to determine the presence of free floating blood in the peritoneum.[3] A
diagnostic peritoneal lavage, while not ideal, may be used to evaluate the presence of internal bleeding a
person who is hemodynamically unstable.[4] The FAST exam
typically serves to evaluate the need to perform a CT scan.[4]
Computed tomography with IV contrast is the preferred imaging
study as it can provide high quality images of the full peritoneal
cavity.[3]

Organ injury scale

Traumatic rupture of the spleen on
American Association for the Surgery of Trauma Organ Injury
contrast enhanced axial CT (portal
Scaling: Splenic Injury Grading[5]
venous phase)

Splenic injury scale classification

Grade Subcapsular hematoma Laceration

<1 cm parenchymal
I <10% surface area
depth

1–3 cm parenchymal
II 10–50% surface area
depth

>3-cm parenchymal
III >50% surface area or expanding
depth

Major devascularization (>25% of

IV
spleen)

V Completely shattered spleen

Splenic hematoma resulting in free

Treatment abdominal blood

Because a splenic rupture permits large amounts of blood to leak

into the abdominal cavity, it can result in shock and death. Generally a nonoperative approach is chosen in
those who are hemodynamically stable with non-worsening symptoms.[5][6] During this period of
nonoperative management strict bed rest between 24 and 72 hours with careful monitoring along with a CT
7 days after the injury.[5]

If an individual's spleen is enlarged, as is frequent in mononucleosis, most physicians will advise against
activities (such as contact sports) where injury to the abdomen could be catastrophic.[7]

Patients whose spleens have been removed via a splenectomy must receive immunizations to help prevent
infections such as pneumonia. This helps to replace the lost function of this organ.

See also
Splenomegaly
Kehr's sign
Ballance's sign

References
1. Aubrey-Bassler, F.; Sowers, N. (2012). "613 cases of splenic rupture without risk factors or
previously diagnosed disease: A systematic review" (https://www.ncbi.nlm.nih.gov/pmc/articl
 es/PMC3532171). BMC Emergency Medicine. 12: 11. doi:10.1186/1471-227X-12-11 (https://
doi.org/10.1186%2F1471-227X-12-11). PMC 3532171 (https://www.ncbi.nlm.nih.gov/pmc/art
icles/PMC3532171). PMID 22889306 (https://pubmed.ncbi.nlm.nih.gov/22889306).
2. Handin, Robert I.; Lux, Samuel E.; Stossel, Thomas P. (2003). Blood: Principles and
Practice of Hematology (https://books.google.com/books?id=H85dwxYTKLwC&pg=PA641).
Lippincott Williams & Wilkins. p. 641. ISBN 9780781719933.
3. Mattox 2012, p. 566
4. Trunkey 2008, p. 401
5. Uranues, Prof Selman; Kilic, Yusuf A. (2008-07-30). "Injuries to the Spleen". European
Journal of Trauma and Emergency Surgery. 34 (4): 355–361. doi:10.1007/s00068-008-8102-
0 (https://doi.org/10.1007%2Fs00068-008-8102-0). ISSN 1863-9933 (https://www.worldcat.o
rg/issn/1863-9933). PMID 26815812 (https://pubmed.ncbi.nlm.nih.gov/26815812).
S2CID 8808584 (https://api.semanticscholar.org/CorpusID:8808584).
6. Mattox 2012, p. 570
7. "About Mono (Infectious Mononucleosis) | CDC" (https://www.cdc.gov/epstein-barr/about-mo
no.html). www.cdc.gov. 2021-03-17. Retrieved 2022-07-17.

Bibliography
Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest J. (2012). Trauma, Seventh Edition
(Trauma (Moore)). McGraw-Hill Professional. ISBN 978-0-07-166351-9.
Trunkey, Donald (2008). Current Therapy of Trauma and Surgical Critical Care (1st ed.).
Philadelphia: Mosby. ISBN 978-0-323-04418-9.

External links

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