What is a ruptured spleen?
A splenic rupture is a tear in the capsule or tissue of the spleen. A ruptured spleen is always an emergency in which doctors must act quickly. This is because bleeding may occur in the abdomen, which can be life-threatening.
In most cases, the cause of splenic rupture is blunt abdominal trauma. Blunt force acts on the abdominal cavity and damages the spleen, for example in a car or sports accident. Sometimes the splenic rupture occurs spontaneously without the involvement of mechanical forces. Examples include infections, inflammations, tumors or blood diseases.
There are two different forms of splenic rupture:
- Single rupture of the spleen: Both the capsule and the tissue rupture and symptoms such as pain in the upper abdomen and circulatory problems set in immediately.
- Two-stage rupture of the spleen: Initially only the tissue of the spleen ruptures and only a few hours, days or weeks later does the capsule also rupture. Initially there are no symptoms and the onset of symptoms is delayed.
There are various treatment options for a ruptured spleen. Which doctors choose depends on the extent and severity of the injury as well as the amount and type of concomitant injuries. Sometimes a ruptured spleen can be treated conservatively without surgery. In other cases, surgery is necessary. However, doctors always try to preserve the spleen, because the spleen fulfills important immunological functions (defense against infection)! Sometimes this is not successful and the spleen has to be partially or completely removed.
Splenic rupture – frequency and age
The frequency of splenic rupture cannot be precisely quantified. In the case of blunt abdominal trauma, however, the spleen is the most frequently damaged organ in the abdominal cavity, accounting for up to 45 percent of cases. About five to six percent are bilateral splenic ruptures (less in children). Non-traumatic splenic ruptures, for example in the context of infections or inflammations, occur less frequently in comparison.
In principle, a ruptured spleen can affect people of any age: Children, adolescents, adults and senior citizens. In addition, people of any gender can suffer a ruptured spleen.
Ruptured spleen: usually caused by abdominal injuries
The most common causes of splenic rupture are blunt abdominal injuries (trauma). The main cause in industrialized countries is traffic accidents – for both adults and children. Particularly in the case of children, the position of the seat belt in the event of a collision can result in a strong force being exerted and the spleen tearing. The risk of a ruptured spleen is particularly high in children because their ribs are still soft and their abdominal muscles are weaker than in adults.
The following causes of splenic rupture are also possible:
- Falls from a great height – this is a common cause, especially among six to ten-year-olds.
- Falling off a bike, for example over the handlebars, is particularly common among eleven to 15-year-olds.
- Motorcycle accidents – the most common cause of spleen rupture in 16 to 18-year-olds
- Accidents at work
- Sports accidents, for example while snowboarding, skiing or boxing
In principle, however, any injury to the abdominal cavity can be associated with a ruptured spleen.
Doctors differentiate between traumatic splenic rupture:
- Blunt, closed abdominal trauma: The skin remains intact. The main cause of such abdominal injuries are car accidents.
- Open, penetrating abdominal trauma: The skin is injured. The causes can be a knife thrust or a gunshot wound.
- Injuries to the chest (thorax), such as a rib fracture at the lower left ribcage (the spleen is located in the upper left abdomen)
- Caused by a doctor (iatrogenic), for example during an operation (e.g. laparotomy), puncture or colonoscopy
Single-stage or double-stage splenic rupture
There are two variants of traumatic splenic rupture:
- Single-stage means that the capsule of the spleen and the tissue are injured. Acute bleeding into the abdominal cavity occurs.
- Two-stage means that the spleen tissue is injured but the capsule is initially still intact – a hematoma forms in the spleen or below the capsule. Only later does the capsule rupture and bleeding into the abdominal cavity occurs.
Spleen rupture: Enlargement of the spleen due to disease
Spontaneous splenic rupture can also occur with an enlarged spleen (splenomegaly). Enlargement of the spleen occurs, for example, in the context of these diseases:
- Malaria – an infectious disease caused by single-celled parasites (plasmodia).
- Pfeiffer’s glandular fever (mononucleosis) – an infection with the Epstein-Barr virus (EBV)
- Blood diseases, for example blood cancer(leukemia) or polycythaemia vera (in which all blood cells – erythrocytes, leukocytes and thrombocytes – multiply)
- Spleen tumors(lymphomas = lymph gland cancer)
- Blood clots (thrombosis) in the portal vein
What does a person need the spleen for?
The spleen is located in the left upper abdomen and is encased in a capsule of connective tissue. A ruptured spleen can have various consequences, as it has important functions in the body. The spleen helps to purify the blood and is part of the lymphatic system – it therefore also has immunological functions. It breaks down red blood cells (erythrocytes) and blood platelets (thrombocytes). It also stores around a quarter of the platelets circulating in the bloodstream as a reserve. If doctors have to remove the spleen, this storage function is lost.
Splenic rupture symptoms
The symptoms of a ruptured spleen depend on whether the rupture is unilateral or bilateral. In a one-stage rupture of the spleen, both the capsule and the tissue of the spleen rupture and bleeding into the abdominal cavity occurs. The symptoms depend on the amount of blood loss. The following complaints may occur:
- Mild to severe pain, especially pressure pain in the left upper abdomen. However, the pain can radiate to other parts of the body, such as the left shoulder (so-called “Kehr’s sign”). Pressure pain on the left side of the neck is also possible (so-called “Saegesser’s sign”).
- Defensive tension of the abdominal wall – it feels hard and is sensitive to pain.
- Gentle breathing due to pain, shortness of breath
- Circulatory disorders up to hemorrhagic shock – a life-threatening situation. This leads to a drop in blood pressure (hypotension) and palpitations (tachycardia).
In a two-stage splenic rupture, the capsule initially remains intact and only the tissue of the spleen is damaged. Those affected therefore experience no or only mild symptoms immediately after the trauma. Only hours, days or weeks later does the capsule of the spleen also rupture – and the symptoms set in:
- Pain in the left upper abdomen
- sudden symptoms of shock – up to and including collapse and cardiovascular arrest
A ruptured spleen is always an emergency. Doctors must treat this immediately to avoid life-threatening consequences.
Ruptured spleen: Diagnosis with us
The diagnosis of a ruptured spleen should always be made as quickly as possible, because a ruptured spleen is an emergency! Bleeding into the abdominal cavity is life-threatening. We have to treat the ruptured spleen immediately and stop the bleeding. Traumatic splenic rupture is often caused by a car accident, sports accident or accident at work. In addition to the ruptured spleen, patients often have other injuries that we need to look at.
If possible, we will ask you a few questions about your medical history, for example:
- What complaints do you have exactly?
- When did you first notice them and how long have they been there?
- How severe are the symptoms?
- Where exactly would you localize the complaints?
- Did the symptoms start suddenly or only after a delay?
- Can you link your symptoms to an event (e.g. accident)?
- Do you have any known underlying illnesses, e.g. malaria, mononucleosis or cancer?
- Are you taking any medications? If yes: Which and since when?
We usually examine our patients physically, for example to identify external injuries such as bruises or belt marks. The sensitivity to pressure pain in certain areas of the body can also be checked in this way. A blood test, in which we repeatedly measure the hemoglobin, is helpful. The hematocrit value and the blood count also allow conclusions to be drawn about a ruptured spleen. We also always monitor the vital parameters: Blood pressure, heart rate, respiration and body temperature. This allows a shock to be recognized at an early stage.
They also use imaging techniques in diagnostics to visualize a ruptured spleen, bleeding and other injuries in the abdominal cavity:
- Ultrasound (sonography) of the abdomen – we repeat the ultrasound examination if the findings are initially unremarkable. This is because there may also be a two-stage rupture of the spleen, in which the capsule of the spleen only tears with a time delay. The bruise is also sometimes small at first and only increases in size later.
- Computed tomography (CT) of the abdomen if the patient’s circulation is sufficiently stable – this method uses X-rays and provides three-dimensional, high-resolution cross-sectional images. A ruptured spleen as well as hematomas and other injuries can thus be easily recognized.
- Magnetic resonance imaging (MRI = magnetic resonance imaging) as an alternative to computer tomography, for example in cases of unstable circulation
- X-ray of the chest, for example in the case of bony injuries
Splenic rupture: degrees of severity
Depending on the extent of the splenic rupture, five degrees of severity or types can be distinguished:
- Isolated capsule tear or bruise under the capsule that does not spread
- Injury to the spleen capsule and spleen tissue – the vascular pedicle on the spleen (splenic hilus) or the splenic arteries are not affected.
- The capsule and tissue are injured and there is bleeding from the arteries of the organ.
- Capsule, tissue, splenic hilus and arteries are injured – the vascular pedicle is torn off.
- The spleen is ruptured or ruptured in the splenic hilus – the blood supply via the vessels is interrupted.
Splenic rupture: prevention, early detection, prognosis
Special measures to prevent splenic rupture in the doctor’s office are not known. Because spleen ruptures often occur in the context of sports or work accidents, you can prevent them to a certain extent by ensuring that you wear adequate protective clothing. Underlying diseases that cause an enlarged spleen are less common. And you can hardly prevent them.
There are also no special measures for the early detection of a ruptured spleen. The general advice is therefore to consult your doctor after every accident during leisure time or sport, even if you experience few or no symptoms – a two-stage splenic rupture could also occur. And if you experience symptoms, a visit to the doctor is always advisable anyway. In the event of a car accident, the emergency services are usually on site quickly anyway.
Course and prognosis of a ruptured spleen
If specialists diagnose and treat the ruptured spleen in good time, the course and prognosis are generally favorable. Mortality is low in this case. However, both depend on whether other injuries are present, which is often the case in a car accident, for example. If only the spleen is injured, factors such as age and the amount of blood loss also play a role in the prognosis.
Ruptured spleen: treatment depends on the severity
There are various treatment options for a ruptured spleen. Which therapy is used depends on the severity of the disease. Specialists can often treat a minor injury to the spleen conservatively without surgery. In more severe cases, however, surgical intervention is necessary.