The Spleen is the most vascular organ in the body. Since bleeding in splenic injuries is mainly arterial, significant hemoperitoneum can occur. Also bleeding from injuries of the spleen is mainly intraperitoneal.
Because of the immunological functions of the spleen, there is a trend towards salvaging the spleen rather than remove it in traumatic cases. The development of CT scan has made conservative management of splenic injuries possible today.
Injuries to the spleen are one of the most common injuries in abdominal trauma. The spleen is the most vascular organ in the body. Since bleeding in splenic injuries is mainly arterial, significant haemoperitoneum can occur. Unrecognized injury can be a cause of preventable traumatic death. This activity reviews the framework for the evaluation and initial management of patients with abdominal trauma with a suspected injury of the spleen and highlights the role of the interprofessional team in managing the patients presenting with it.
Signs and symptoms of a ruptured spleen include
- Pain in the upper left abdomen
- Tenderness when you touch the upper left abdomen
- Left shoulder pain
- Confusion, lightheadedness or dizziness
A spleen can rupture due to:
- Injury to the left side of the body. A ruptured spleen is typically caused by a blow to the left upper abdomen or the left lower chest, such as might happen during sporting mishaps, fistfights and car crashes. An injured spleen can rupture soon after the abdominal trauma or, in some cases, days or weeks after the injury.
- An enlarged spleen. Your spleen can become enlarged when blood cells accumulate in the spleen. An enlarged spleen can be caused by various underlying problems, such as mononucleosis and other infections, liver disease, and blood cancers.
A ruptured spleen can cause life-threatening bleeding into your abdominal cavity.
If you've been diagnosed with an enlarged spleen, ask your doctor whether you need to avoid activities for several weeks that could cause it to rupture. These might include contact sports, heavy lifting and other activities that increase the risk of abdominal trauma.
Splenic rupture is usually evaluated by FAST ultrasound of the abdomen. Generally this is not specific to splenic injury; however, it is useful to determine the presence of free floating blood in the peritoneum. A diagnostic peritoneal lavage, while not ideal, may be used to evaluate the presence of internal bleeding a person who is hemodynamically unstable.The FAST exam typically serves to evaluate the need to perform a CT. Computed tomography with IV contrast is the preferred imaging study as it can provide high quality images of the full peritoneal cavity.
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. During this period of nonoperative management strict bed rest between 24–72 hours with careful monitoring along with a CT 7 days after the injury.
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.
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.
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Clinical Gastroenterology Journal