Spleen rupture: symptoms, diagnosis, treatment

With a traumatic effect of high power on the spleen, its integrity is disturbed. This concept in medicine is defined as rupture of the spleen. The consequence of the rupture is a high-energy blow to the region of the lower part of the chest on the left side, and the slaughter of the left hypochondrium can also lead to a similar condition. Chest injuries damage not only the spleen, but also other organs of the peritoneum. A rupture of the spleen is determined by pain in the left hypochondrium, supplemented by signs of blood loss. The diagnosis is confirmed only after the results of a comprehensive diagnosis (laparoscopy and others). Upon confirmation of the diagnosis, treatment is prescribed only by surgery.

What is a ruptured spleen

The main causes of organ damage are car accidents, falling from a height, a strong blow to the area of ​​the spleen. This is definitely a life-threatening injury, as it is characterized by profuse bleeding. Therefore, urgent surgical intervention is required.

Statistics. It was found that spleen rupture is diagnosed most often in physically active people of working age, as well as in people involved in extreme sports.

After an injury, a rupture of this organ can be not only an isolated injury, but also a polytrauma, that is, in combination with damage to other organs (mainly the colon, liver). During a car accident, a rupture of the spleen is complemented by bruises of the chest, broken ribs, damage to the spine, limbs. In this case, only an abdominal surgeon can eliminate the consequences of damage. Sometimes the help of a traumatologist is required.

If we consider the spleen from the point of view of anatomy, then this organ is covered with a special capsule, characterized by an elongated shape resembling a hemisphere. It is localized in the region of 9-11 ribs, behind the stomach in the left side of the peritoneum. This is not to say that this is a vital organ, however, if damaged, severe bleeding can occur, which is life-threatening. The main function of the spleen is to restore blood balance.

Factors leading to rupture of the spleen:

• a thin capsule covering an organ;
• insufficient mobility of the spleen;
• plethora of the organ.

Attention! The ribs protect the spleen from slaughter, but the degree of damage will depend on the force of the blow, breathing at the time of injury and the location of the organ.

Damage classification

Break type	a brief description of
Contusion	The integrity of the capsule covering the spleen is preserved, but part of the parenchyma is damaged.
Damage to the capsule	In this case, the integrity of the parenchyma is absolutely not affected.
One-time break	During an injury, the capsule and the parenchyma are simultaneously damaged.
Two-moment rupture	Initially, the parenchyma is torn, after which, after a certain period of time, the spleen.
Break with self tamponade	The parenchyma and spleen are torn. When the parenchyma ruptures, a blood clot forms that closes it. After a while, the clot is flushed out by the blood stream and bleeding resumes.
Imaginary three-moment	This rupture is initially determined by two-stage, and after rupture with tamponade and subsequent bleeding.

Attention! The most common in medical practice are one-stage ruptures, after which slow bleeding occurs. As for the two-stage, they barely exceed 10% of all cases in which bleeding begins one week after the injury.

After injury, the capsule may rupture under the influence of a secondary factor. For example, a patient coughs, turns in bed, performs physical activity, runs - all this leads to an increase in pressure in the spleen. The result is a rupture of the organ.

In most cases, the breaks are minor and are characterized by blurred symptoms. Therefore, the diagnosis is often late, when the first signs begin to appear. The patient feels a significant deterioration in well-being, provoked by blood loss and the accumulation of blood in the peritoneum.

Reference. With a two-stage rupture, profuse bleeding occurs.

Symptoms

The clinical picture with damage to the spleen is very peculiar. The severity of symptoms directly depends on the degree of damage to the organ, concomitant damage to other organs.

Upon receiving an injury, a person feels a slight deterioration in well-being, in some cases there are signs of blood loss. Initially, the patient begins to complain of pain in the left hypochondrium and in the upper abdomen. 50% of cases are characterized by pain irradiation to the area of ​​the right scapula.

Painful sensations force the patient to lie down on the left side for relief. The severity of the pain syndrome varies depending on the period after the injury. The specialist must without fail palpation of the abdominal cavity. For example, when a collapse occurs, the abdominal muscles are relaxed.

Among the symptoms, intestinal paresis should be distinguished:

• bloating;
• impossibility of normal bowel movements;
• problems with the removal of gases.

Additionally, the following visible signs of rupture of the spleen are observed:

• blood pressure decreases;
• the pulse quickens significantly;
  

  A sharp increase in heart rate is one of the symptoms of damage to the spleen and internal bleeding

• the patient's head begins to spin;
• weakness arises, which progresses rapidly;
• there is nausea, leading to vomiting;
  

  The condition is worsened by attacks of nausea, turning into vomiting

• often loss of consciousness;
• pallor of the skin;
• dyspnea;
  

  It becomes difficult for the patient to breathe, shortness of breath occurs

• the patient is thrown into cold sweat;
• noises in the ears.

Note! With a ruptured spleen, the pulse will be over 120 beats. min.

The main symptom warning of a ruptured spleen is pain in the left hypochondrium. The rest of the above symptoms are not able to accurately confirm the diagnosis, since similar symptoms are observed with various exacerbations in the abdominal cavity.

Diagnostics

It makes no sense to examine the peripheral blood for several hours after the injury, since its composition, despite the bleeding, will be within the normal range. Therefore, the patient is primarily referred for abdominal and chest x-ray.

If the radiography reveals a homogeneous shadow under the diaphragm on the left side, then a spleen injury is diagnosed. Also, the rupture of the organ is evidenced by the expansion of the stomach area, displacement of the stomach, displacement of the colon. Since the clinical picture is mild, the results of radiography may be nonspecific. The doctor, if necessary, directs for angiography (this diagnostic method is not in demand, since it is time-consuming).

The most common method for examining a damaged spleen is laparoscopy. Thanks to this technique, abdominal bleeding and the presence of damage in the organ are determined as soon as possible. Laparocentesis is recognized as an alternative research method - through this study, the source of bleeding is established.

Treatment methods

The most dangerous manifestation of a ruptured spleen is bleeding. One in a hundred clinical cases where bleeding stops on its own. Basically, to save a patient's life, urgent surgical intervention is required. It is categorically contraindicated to procrastinate, since the increasing blood loss significantly worsens further forecasts.

Important! The spleen does not belong to the vital organs, therefore, after its removal, a person can continue full activity, however, its rupture is accompanied by severe abdominal bleeding, which threatens life.

Before surgery, specialists stabilize hemodynamics. For this, a blood transfusion is performed. However, there may be extremely severe cases when there is no possibility to stabilize hemodynamic parameters. Then the operation is performed urgently (in parallel, resuscitation actions are performed).

To stop the blood loss, they resort to the complete removal of the organ. However, with the development of medical capabilities, surgeons are trying to preserve the organ by suturing. This operation is possible only with shallow damage to the spleen.

If the rupture of the organ is extensive, then complete removal of the spleen is required. In the future, during the rehabilitation period after surgery, the patient may experience intravenous blood infusions.

Video - Ruptured spleen: symptoms