Splenic rupture
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Rupture of the capsule of the spleen, an organ in the upper left part of the abdomen, is a potential catastrophe that requires immediate medical and surgical attention.
Causes
Life Threatening Causes
Common Causes
Common Causes: [1]
Traumatic causes:
- Road traffic accidents
- Contact sports injuries (Hockey and Football)
- Stab and gunshot wounds
- Domestic violence
- Fist fights
Non-Traumatic causes:
- Pancreatitis (Acute and Chronic)
- Lymphoma (malignant haematological disorders)
- Leukaemia (malignant haematological disorders)
- Splenic neoplasms such as the angiosarcoma and haemangioma
- Langerhans cell histiocytosis (non-malignant haematological disorders)
- Viral infections such as the infectious mononucleosis, HIV and cytomegalovirus (CMV) infection
- Bacterial infections such as the infectious endocarditis and tuberculosis
- Parasitic infections such as the malaria
- Primary and secondary amyloidosis
- Colonoscopy increases the risk of splenic rupture. [2]
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Filgastrim, Tbo-filgrastim |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal/Electrolyte | No underlying causes |
| Rheumatology/Immunology/Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical Order
Pathophysiology
The spleen is an organ in the upper left side of the abdomen that filters the blood by removing old or damaged blood cells and platelets and helps the immune system by destroying bacteria and other foreign substances. It also holds extra blood that can be released into the circulatory system, if needed.
Symptoms
Symptoms of Splenic rupture include: [3] [4] [5] [6] [7]
- Upper left abdominal pain
- Upper left abdominal tenderness
- Left shoulder pain (Sharp pain - Kehr's sign)
- Confusion, dizziness and lightheadedness
- Blurred vision
- Tachycardia ("racing heart" feel)
- Profuse sweating
- Dyspnea
- Extensive injury may result in excessive bleeding leading to hypotension and finally hypovolemic shock
Prognosis
Splenic rupture permits large amounts of blood to leak into the abdominal cavity which is severely painful and life-threatening. Shock and, ultimately, death can result. Patients typically require an urgent operation, although 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 itself. Rupture of a normal spleen can be caused by trauma, for example, in an accident. If an individual's spleen is enlarged, as is frequent in mononucleosis, most physicians will not allow activities (such as major contact sports) where injury to the abdomen could be catastrophic.
Prevention
The spleen is a useful but nonessential organ. It is sometimes removed (otherwise known as a splenectomy) in people who have blood disorders, such as thalassemia or hemolytic anemia. If the spleen is removed, a person must get certain immunizations to help prevent infections that the spleen normally fights.
Related Chapters
Resources
References
- ↑ Aubrey-Bassler FK, Sowers N (2012). "613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review". BMC Emerg Med. 12: 11. doi:10.1186/1471-227X-12-11. PMC 3532171. PMID 22889306.
- ↑ Fishback SJ, Pickhardt PJ, Bhalla S, Menias CO, Congdon RG, Macari M (2011). "Delayed presentation of splenic rupture following colonoscopy: clinical and CT findings". Emerg Radiol. 18 (6): 539–44. doi:10.1007/s10140-011-0982-3. PMID 21887533.
- ↑ Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE; et al. (2017). "Splenic trauma: WSES classification and guidelines for adult and pediatric patients". World J Emerg Surg. 12: 40. doi:10.1186/s13017-017-0151-4. PMC 5562999. PMID 28828034.
- ↑ Barone JE, Burns G, Svehlak SA, Tucker JB, Bell T, Korwin S; et al. (1999). "Management of blunt splenic trauma in patients older than 55 years. Southern Connecticut Regional Trauma Quality Assurance Committee". J Trauma. 46 (1): 87–90. PMID 9932688.
- ↑ Beuran M, Gheju I, Venter MD, Marian RC, Smarandache R (2012). "Non-operative management of splenic trauma". J Med Life. 5 (1): 47–58. PMC 3307080. PMID 22574087.
- ↑ Pachter HL, Guth AA, Hofstetter SR, Spencer FC (1998). "Changing patterns in the management of splenic trauma: the impact of nonoperative management". Ann Surg. 227 (5): 708–17, discussion 717-9. PMC 1191351. PMID 9605662.
- ↑ Cadeddu M, Garnett A, Al-Anezi K, Farrokhyar F (2006). "Management of spleen injuries in the adult trauma population: a ten-year experience". Can J Surg. 49 (6): 386–90. PMC 3207549. PMID 17234065.
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