Overview
A ruptured spleen is a medical emergency that occurs when the surface of the spleen, a small organ located on the left side of the abdomen, breaks. The spleen helps the body fight infection and filter old blood cells. A ruptured spleen typically results from a forceful blow to the stomach, such as during a sports accident, fistfight, or car crash. In some cases, an enlarged spleen may rupture from less forceful trauma. The internal bleeding caused by a ruptured spleen can be life-threatening if left untreated. Symptoms may include pain in the upper left stomach, tenderness when touching the affected area, left shoulder pain, and confusion, lightheadedness, or dizziness. Emergency treatment, such as surgery, may be required to address a ruptured spleen.
Understanding the disease
Symptoms
A ruptured spleen can be a medical emergency, and symptoms may include:
- Sudden, severe pain in the upper left abdomen that may radiate to the back.
- Persistent and severe abdominal pain that worsens with deep breathing or coughing.
- Shock, resulting in a rapid heartbeat, rapid breathing, and lightheadedness.
- Pale or ashen skin.
- Rapid pulse.
- Chills or fever.
- Nausea or vomiting. If you or someone you know is experiencing these symptoms, it is crucial to seek immediate medical attention.
Risk Factors
Risk factors for developing a ruptured spleen include:
- Injury to the left side of the body: A ruptured spleen is typically caused by a blow to the left upper stomach or the left lower chest, which can occur during sporting accidents, fistfights, or car crashes.
- An enlarged spleen: The spleen can become enlarged when blood cells accumulate in the spleen. An enlarged spleen can be caused by various underlying problems such as mononucleosis, infections, liver disease, and blood cancers.
- Weakened immune system: Factors that affect the immune system, such as AIDS, alcohol use disorder, diabetes, immunosuppressant drugs, and other conditions, increase the risk of a ruptured spleen. It's important to consult a healthcare provider if you have been diagnosed with an enlarged spleen to determine if there are any activities that should be avoided to prevent a ruptured spleen.
Development
The various causes of a ruptured spleen are:
- Injury to the left side of the body: A ruptured spleen is typically caused by a blow to the left upper stomach or the left lower chest, such as might happen during sporting accidents, fistfights, and car crashes.
- 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.
- Lung disease: Damaged lung tissue is more likely to collapse. Lung damage can be caused by many types of underlying diseases, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, lung cancer, or pneumonia. Cystic lung diseases, such as lymphangioleiomyomatosis and Birt-Hogg-Dube syndrome, cause round, thin-walled air sacs in the lung tissue that can rupture, resulting in pneumothorax.
- Ruptured air blisters: Small air blisters (blebs) can develop on the top of the lungs. These air blisters sometimes burst, allowing air to leak into the space that surrounds the lungs.
- Mechanical ventilation: A severe type of pneumothorax can occur in people who need mechanical assistance to breathe. The ventilator can create an imbalance of air pressure within the chest, causing the lung to collapse completely.
Assessment and Diagnosis
Triage
You should see a doctor immediately if you suspect a ruptured spleen. Ruptured spleens are medical emergencies that require prompt attention. Seek emergency care after an injury if your signs and symptoms, such as pain in the upper left stomach, tenderness when you touch the upper left stomach, left shoulder pain, and confusion, lightheadedness, or dizziness, indicate that you may have a ruptured spleen.
Diagnosis
To diagnose a ruptured spleen, your healthcare provider will likely perform a physical exam to check the size and tenderness of your spleen. Blood tests will also be conducted to evaluate factors like platelet count and blood clotting. In emergency situations, imaging tests such as ultrasound or CT scans may be used to check for blood in the abdominal cavity. If the diagnosis isn't clear, your provider may recommend additional imaging tests like a CT scan.
Management and Treatment
Complications
Complications of a ruptured spleen may include life-threatening bleeding into the stomach cavity, and in severe cases, sepsis. Sepsis is a potentially life-threatening condition that can occur if bacteria spread through the bloodstream, causing inflammation throughout the body. Sepsis can lead to organ failure and, in severe cases, septic shock. The mortality rate for septic shock is approximately 30-40%, and it can increase the risk of future infections.
Treatment
The treatment for a ruptured spleen depends on the severity of the condition. Severe injuries usually require immediate surgery. In some cases, small or moderate-sized injuries can heal without surgery, and nonsurgical care such as blood transfusions might be provided. If needed, surgical procedures can include repairing the spleen or removing it entirely. The choice of treatment will depend on the specific situation and the advice of a healthcare provider.