Ruptured spleen: symptoms, diagnosis and treatment

Overview

The spleen is the second largest organ of the reticuloendothelial system. It is located in the left upper quadrant of the abdomen and it is in close contact with the diaphragm, stomach, pancreas, left kidney and left flexure of the colon. Its vascular stalk consists of a splenic artery and a splenic vein. The normal spleen is dark red in color, measuring 14x8x3 cm and weighing 100 to 175 grams, and is wrapped in a thin capsule.

Functions of the spleen in the body

The most important functions of the spleen are:

1. Depot function - special ability to increase its volume.
2. Metabolic function - the regulatory center of glycine, lipid and amino acid metabolism.
3. Immune function - the largest lymphatic organ.
4. Blood cell filtration.
5. Hematopoiesis - the formation of blood elements is reflected in embryonic development, before the development of bone marrow.

Types of spleen injury

The spleen is one of the most commonly injured intra-abdominal organs in blunt trauma. In relation to the severity of the injury, the following types of spleen injury exist:

1. Type I - subcapsular or intraparenchymal hematoma, without capsule laceration.
2. Type II - open laceration of the parenchyma that does not spread to the hilus.
3. Type III - open laceration that spreads to the hilus.
4. Type IV - splenic hilus disruption or splenic avulsion.

Spleen injury should be considered in blunt injury of the left hemiabdomen.

Symptoms

Clinical signs of splenic injury are symptoms of hypovolemia and hemoperitoneum.

Hypovolemia as a symptom of splenic rupture

Hypovolemia is a reduction in the volume of circulating blood in the body. This condition can be caused by bleeding or loss of body fluids due to diarrhea, vomiting or excessive sweating. Hypovolemia is also caused by burns, the use of diuretics or insufficient fluid intake. The main symptom is dryness of the oral cavity, nose and other mucous membranes. Then there is a decrease in skin elasticity as well as urine production. If the loss of blood and fluid is not compensated adequately, the patient can enter hypovolemic shock, a condition in which one-fifth of the circulating blood is lost.

Symptoms of hypovolemia:

• sweating
• pale skin
• rapid breathing
• increased heart rate
• weakness
• anxiety
• confusion
• disturbance of consciousness

Hemoperitoneum as a symptom of splenic rupture

Hemoperitoneum is a type of internal bleeding, which means that blood accumulates in the peritoneal cavity. The peritoneal cavity is a small space located between the internal abdominal organs and the abdominal wall. Blood in this part of the body can appear due to physical trauma, rupture of a blood vessel or organ, as well as due to ectopic pregnancy. In all these cases, urgent medical help is necessary.

Diagnosis

Diagnosis of splenic rupture is established by native and contrast radiography, ultrasonography and CT imaging.

Treatment of splenic rupture

The most commonly used surgical procedure for splenic injury and rupture is splenectomy. Rupture of the spleen can occur immediately after the injury and after a certain time of latent bleeding. In 1866, Evans described that the spleen can bleed after an injury, because bleeding in the parenchyma of the spleen, without laceration of the capsule, can be stopped for some time, and the osmotic activity of the spilled blood can subsequently lead to rupture of the capsule and bleeding. This clinical latency period averages up to two weeks from injury, but rupture may occur later. After splenectomy in children, there is an increased sensitivity to gram-negative bacteria and the possible development of postplenectomy sepsis. Whenever possible, splenectomy in children should be postponed until the age of four.