Ruptured Spleen: Symptoms, Causes, Treatment

Ruptured Spleen: Symptoms, Causes, Treatment


A ruptured spleen, or splenic rupture, is when the spleen tears open. The spleen is a fist-sized organ located in the upper left abdomen. As part of the lymphatic system, it helps filter blood and eliminate old blood cells. It also produces lymphocytes, which are white blood cells that help the body fight infections.

A traumatic blow to the stomach—from a car accident or fall, for example—is the most common cause of a ruptured spleen. In some cases, a spleen enlarged due to illness can rupture spontaneously.

As the spleen bleeds into the abdominal cavity, you may experience pain in your upper left abdomen that radiates to your left shoulder. Your belly may also be visibly swollen as blood collects in your abdomen.

While splenic ruptures are not common, the spleen is the most frequently injured organ in the abdomen, accounting for 42% of all traumatic abdominal injuries. A ruptured spleen always requires medical attention treatment, but treatment options vary depending on the severity of the injury. 

The most common symptom of a ruptured spleen is moderate-to-severe pain in the upper left abdomen behind the ribs. The pain may radiate to the left shoulder blade, and some people also experience left-sided chest pain. Your belly may feel tender when touched and appear swollen. 

Symptoms of splenic rupture often develop suddenly following a blow to the stomach, but in some cases, it can take up to 10 days after an injury for symptoms to appear. 

The spleen contains many blood vessels since one of its primary functions is filtering blood. Injury to the spleen can damage these blood vessels and cause significant bleeding that leaks into the abdominal cavity. If you lose a lot of blood, you may also experience hypovolemic shock, an emergency when your body loses too much blood. Symptoms of hypovolemic shock include:

  • Lightheadedness
  • Blurred vision
  • Confusion 
  • Anxiety or agitation
  • Sweating
  • Cool, clammy skin
  • Weakness
  • Rapid breathing 
  • Fainting (loss of consciousness)

A ruptured spleen occurs when the spleen’s capsule—the thick layer of connective tissue surrounding the spleen—tears and bleeds. This tear causes blood to leak from the spleen into the abdomen.

The most common cause of a ruptured spleen is blunt trauma to the abdomen, meaning a forceful impact on the belly, often from a car accident, sports injury, or fall. Penetrating trauma (injury that breaks the skin) from gunshot wounds or stabbings accounts for approximately 9% of all splenic ruptures.

Although rare, some illnesses that cause inflammation and enlargement of the spleen (splenomegaly) can weaken the spleen’s capsule and lead to non-traumatic (spontaneous) splenic rupture. Infections like mononucleosis (also known as mono) and hepatitis, as well as connective tissue disorders and certain cancers, can cause an enlarged spleen and increase the risk of splenic rupture from minor trauma.

Risk Factors

Certain factors can increase your risk of a ruptured spleen, including:

  • Contact sports: Playing contact sports, such as football or hockey, can put you at risk for blows to the spleen.
  • Underlying conditions: Medical conditions that cause enlargement or inflammation of the spleen, such as connective tissue disorders like rheumatoid arthritis (RA), certain cancers like leukemia or lymphoma, blood disorders like sickle cell disease, and infections like mononucleosis and hepatitis, can weaken the spleen.
  • Previous abdominal surgery or procedures: Injury to the spleen is a risk of some abdominal surgeries or medical procedures, such as a colonoscopy.

Diagnosing a ruptured spleen involves a medical history review, physical examination, and diagnostic tests. Your healthcare provider will review your medical history and ask about your symptoms. They may ask where you feel pain and whether you’ve experienced a recent accident or blow to your stomach. 

During the physical exam, your healthcare provider will likely touch your abdomen to look for signs of swelling, rigidity (tight muscles), and tenderness.

Imaging tests can confirm the presence and severity of a splenic rupture and internal bleeding. One test may be a focused assessment with sonography for trauma (FAST). This quick bedside ultrasound exam uses sound waves to create pictures of your abdomen to detect the presence of free fluid (blood) in the abdomen.

They might also perform a computed tomography (CT) scan. This involves using a computer and X-rays to create detailed images of the spleen and surrounding area to identify the location of the splenic rupture and the extent of internal bleeding. 

Treatments for a ruptured spleen aim to stop internal bleeding, promote healing, and preserve the spleen’s function. Treatment approaches vary, depending on the severity of the rupture and bleeding. 

Non-Operative Management

Managing the rupture without surgery is the preferred treatment for a ruptured spleen if your vital signs, such as your heart rate and blood pressure, are stable and the rupture is not causing significant internal bleeding.

Non-operative management of a ruptured spleen generally involves:

  • Observation: You may require a hospital stay so healthcare providers can closely monitor your condition and routinely check for signs of worsening bleeding or complications. 
  • Bed rest: You will need to rest and avoid activities that can worsen the splenic injury and increase the risk of more severe bleeding. 
  • Medications: You may receive intravenous (IV) fluid medications for pain management as needed. 

Your healthcare provider will probably order a follow-up imaging test before discharging you from the hospital to assess your healing progress and ensure your spleen is no longer bleeding. 

Surgery 

A ruptured spleen causing severe internal bleeding requires surgical intervention. The type of surgery your healthcare provider performs will depend on the extent of the injury and the severity of the bleeding. Surgical procedures for a ruptured spleen include: 

  • Splenic artery embolization: This involves placing permanent or temporary embolization (clotting) materials, such as coil, glue, vascular plugs, or gel foam, into the artery that supplies blood to the injured area to stop the bleeding.
  • SplenorrhaphyThis involves repairing the spleen using electrocautery (heat with an electric current) to control bleeding and preserve the organ’s function. 
  • Splenectomy: Splenic ruptures that cause uncontrollable bleeding may require surgery to remove the spleen.

There is no guaranteed way to prevent a ruptured spleen, but certain measures may help lower your risk. For example, if you have a condition that inflames or enlarges your spleen, your healthcare provider may ask you to avoid contact sports for a certain period or indefinitely to prevent splenic rupture.

If you experienced a traumatic blow to your abdomen, seek prompt medical attention to ensure early detection and treatment for any injury to your spleen. 

A ruptured spleen can lead to serious complications and requires prompt treatment.

One potential complication is hypovolemic shock, an emergency when the heart is unable to pump enough blood to the body because there has been severe blood loss. Severe internal bleeding from a ruptured spleen can cause rapid blood loss and lead to hypovolemic shock. Hypovolemic shock requires immediate treatment to prevent organ failure or death. 

Another potential complication from a ruptured spleen is peritonitis, or inflammation of the peritoneum (the thin lining of the abdominal walls). Blood leaking from a ruptured spleen into the abdominal cavity can cause peritonitis. Peritonitis requires prompt antibiotic treatment and possibly surgery to prevent systemic (bodywide) infection and organ damage.

A ruptured spleen occurs when the spleen tears and bleeds, usually from blunt trauma to the abdomen from car accidents, sports injuries, and falls. In some cases, infections and conditions that cause an enlarged spleen lead to spontaneous rupture of the spleen. Pain and tenderness in the upper left abdomen that radiates to the left shoulder is the most common symptom. 

Treatment depends on the severity of the rupture and bleeding. Non-surgical treatment involves rest, observation, and symptom management to promote healing. Moderate-to-severe splenic ruptures may require surgery to repair or remove the spleen. Early diagnosis and treatment are important for preventing complications like shock and infection. 

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