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Side of thorax, showing surface markings for bones, lungs (purple), pleura (blue), and spleen (green).
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Rupture of the capsule of the spleen, an organ in the upper left part of the abdomen, is a situation that requires immediate medical attention. The rupture of a normal spleen can be caused by trauma, such as a motor vehicle accident.
Function in the body
The spleen is an organ in the left upper quadrant of the abdomen that filters blood by removing old or damaged blood cells and platelets. While not essential to sustain life, the spleen performs protective immunological functions in the body. It also helps the immune system by destroying bacteria and other foreign substances by opsonization and phagocytosis, and by producing antibodies. It also stores approximately 33 percent of all platelets in the body.
The most common cause of a ruptured spleen is blunt abdominal trauma, such as in traffic 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.
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.
Splenic rupture is usually diagnosed by ultrasound of the abdomen. Ultrasound can detect free fluid due to bleeding and might directly show damage to the spleen itself. Radiographs of the thorax and abdomen might be performed to exclude other injuries. In stable patients, computed tomography of the abdomen can give a fuller overview of the splenic and other injuries. In the past, a diagnostic peritoneal lavage was often used to detect intra-abdominal blood, but this has largely been superseded by modern imaging.
Because a splenic rupture permits large amounts of blood to leak into the abdominal cavity, it can result in shock and death. In the past, this would routinely be treated with emergency surgery and possible removal of the spleen, but it is becoming more common to simply monitor the patient to make sure the bleeding stops by itself, and to allow the spleen to heal on its own.
Patients whose spleens have been removed must receive immunizations to help prevent infections such as pneumonia. This helps to replace the lost function of this organ.
Organ Injury Scale
- Grade I - Hematoma: subcapsular, <10 percent of surface area. Laceration: capsular tear <1 cm in depth into the parenchyma.
- Grade II - Hematoma: subcapsular, 10 to 50 percent of surface area. Laceration: capsular tear, 1 to 3 cm in depth, but not involving a trabecular vessel.
- Grade III - Hematoma: subcapsular, >50 percent of surface area OR expanding, ruptured subcapsular or parenchymal hematoma OR intraparenchymal hematoma >5 cm or expanding. Laceration: >3 cm in depth or involving a trabecular vessel.
- Grade IV - Laceration involving segmental or hilar vessels with major devascularization (ie, >25 percent of spleen).
- Grade V - Hematoma: shattered spleen. Laceration: hilar vascular injury which devascularizes spleen.
- Aubrey-Bassler, F.; Sowers, N. (2012). "613 cases of splenic rupture without risk factors or previously diagnosed disease: A systematic review". BMC Emergency Medicine 12: 11. doi:10.1186/1471-227X-12-11. PMC 3532171. PMID 22889306.
- "WebMD". Retrieved 10 December 2013.
- "AAST Spleen injury scale". Retrieved 15 July 2014.