Ruptured Spleen

1 What is a ruptured spleen?

A ruptured spleen is a medical emergency that occurs when your spleen develops a break in its surface.

Your spleen, located just under your rib cage on the left side, helps your body fight infection and filters old blood cells from your bloodstream.

A ruptured spleen is generally caused by a forceful blow to your abdomen, during a sporting mishap, a fistfight, or a car crash, for example.

Without emergency treatment, a ruptured spleen can cause life-threatening internal bleeding.

Though some ruptured spleens require emergency surgery, some people with ruptured spleens can be treated with several days of hospital care. At times, surgical procedures may be carried out to seal the rupture. It is important that you seek out medical attention right away since any delay could lead to massive internal bleeding, resulting in a complete collapse.

2 Symptoms

The most common signs and symptoms of a ruptured spleen are pain and tenderness in the upper left part of the abdomen and pain in the left shoulder.

A ruptured spleen is described as an emergency state of extensive internal bleeding because the spleen is the depot of blood.

The patient may experience some of the following symptoms due to loss of blood pressure from internal bleeding:

  • Lightheadedness: One of the symptoms of a ruptured spleen is a sudden drop in blood pressure which can cause you to experience lightheadedness. You need to head to the emergency room since a ruptured spleen can restrict the flow of blood to other organs of your body and may even turn fatal if not treated on time.
  • Confusion: It is not uncommon for patients with a ruptured spleen to appear confused and disoriented. Because their blood pressure has dropped on account of the rupture, this can impact normal functioning of other major organs. If you are experiencing similar symptoms, it is important that you seek medical attention right away and get yourself treated for splenic rupture.
  • Blurred vision: With a ruptured spleen, chances are high that your vision will also be impacted. You may experience blurred or double vision on account of the loss of blood pressure. If this occurs, seek immediate treatment.
  • Pain: If you have ruptured your spleen, you will start experiencing excruciating pain in the abdominal area. In fact, one of the first things any doctor will do to determine if the spleen is indeed ruptured is palpate the concerned area and run a simple test. Once the diagnosis is confirmed, the doctor will then prescribe the adequate treatment for your rupture.
  • Fainting: You are likely to experience dizzy spells and may even faint a few times due to sudden and unexpected drop in blood pressure, which will start impacting all major organs of your body unless treated in a timely manner.

3 Causes

The most common cause of a ruptured spleen is injury to the left side of the body, typically at the left upper part of the abdomen or left lower chest.

This happens quite often during sporting mishaps such as wrestling or boxing, fistfights, and car crashes. Falling down on the left part of the body with a high enough pressure could even rupture the spleen. Some of the most common causes for this condition are:

  • Motor vehicle accidents: Most ruptured spleen incidents occur on account of motor vehicle accidents. If you were in an accident and are feeling dizzy along with sharp bouts of pain radiating outwards from the abdominal cavity, you need to get yourself checked out at the closest emergency room. It is not unheard for patients to remain unaware of their ruptured spleen until it is too late for effective treatment, so seek medical help right away.
  • Contact sports: If you have injured yourself while playing sports and feel disoriented and confused, coupled with pain in the abdominal area, chances are high that you may have ruptured your spleen. Head to the nearest emergency room and seek immediate treatment.
  • Bicycle accidents: Bicycles are also known to cause a ruptured spleen. This usually occurs when the rider brakes suddenly and falls forward onto the handle bars. If you experience any of the above symptoms after a bicycle incident, you need to check in with a doctor right away and get diagnosed.
  • Domestic violence: Domestic violence is known to rupture spleens more often than not. If you are experiencing disorientation along with lightheadedness, chances are high that your spleen is ruptured and you need immediate medical treatment.

Generally, the spleen ruptures within a few seconds of injury, but there are some cases in which the spleen takes a couple days or weeks to rupture.

Another rare cause of ruptured spleen is an enlarged spleen, which in turn can be caused by several endogenous (within the body) factors like liver disease, blood cancer, and some infections like mononucleosis.

4 Making a diagnosis

To diagnose a ruptured spleen, some diagnostic tests are carried out which include:

  • Physical examination: The doctor will palpate the spleen and look for any tenderness on the abdominal cavity. Furthermore, the doctor will see if there are any additional indications of internal bleeding, such as skin discoloration, dizziness, nausea, etc.
  • Fluctuation: For internal bleeding, doctors will look for a fluctuation symptom. For this, the doctor will place two hands on the abdomen, and with one hand, give a jerk to the abdomen to try and feel fluid waves with the other hand. If the fluctuation symptom is positive, it is a sign of internal bleeding.
  • Abdominal puncture: A puncture in the abdomen with a needle is performed to check for the presence of blood. If there is, it will be considered an emergency case.
  • Imaging: Imaging tests of your abdomen will be performed to rule out other possible conditions.

5 Treatment

Depending on the severity of the ruptured spleen, the doctor may recommend treatments like immediate surgery or conservative therapy.

A ruptured spleen may heal with rest and time in minor cases, but if the damage is significant, then immediate surgery is recommended.

In conservative therapy, during the period of hospitalization, doctors will carefully monitor the condition and provide non-surgical care such as blood transfusions.

Regular CT scans are performed to ensure the spleen is healing.

Surgical treatment of the spleen includes stitches applied to the ruptured spleen if the injury is not major.

A partial (subtotal) splenectomy is carried out if the spleen is injured in such a way as to allow part of it to be removed.

Surgical removal of the spleen (total splenectomy) will be performed in severe conditions.

Although the spleen is an important organ, it is possible to live without it. Surgery to remove the spleen is done by making several small incisions through the abdomen with the aid of tools and a camera. Then, the surgeon performs careful ligation of the arteries and veins which enter and exit the spleen, and separates the ligaments to remove the spleen.

The surgeon may also use large incisions to access the spleen. After removal, the incisions made are closed with stitches.

6 Prevention

Protecting the spleen from bumps and blows can prevent it from rupturing.

A common cause of ruptured spleen is enlargement.

There are many reasons for an enlargement of the spleen, such as:

  • Infections caused by the mononucleosis virus
  • Presence of cysts in the liver
  • Compensatory hypertrophy

If diagnosed with spleen enlargement, some activities must be avoided, including high-contact sports like:

  • Wrestling: Even the slightest impact in or around your abdomen can rupture your spleen when it is enlarged, so it is important to avoid a grappling sport like wrestling
  • Boxing: The same applies to boxing as well since repeated jabs or thrusts in the abdomen area can lead to a ruptured spleen
  • Weight lifting: Since you strain your pelvic and abdominal muscles when lifting weights, you could end up rupturing your spleen if it is enlarged

7 Lifestyle and coping

A person with a ruptured spleen must avoid certain activities and adopt a better lifestyle. Consult your doctor to help determine what changes you need to make. You should avoid all high-contact sports, as well as weight lifting and most physical exercises for a while, as these strain your abdominal muscles.

It will not take much time to recover from a minor rupture of the spleen, but in the case of surgeries, it will take longer to heal. You will need to alter your diet and make a few changes to your lifestyle until you have completely recovered. It is also not unheard of for patients to develop weakened immunity on account of the splenectomy, as can occur with any surgery.

8 Risks and complications

There are several complications associated with a ruptured spleen.

A ruptured spleen may cause severe internal bleeding, leading to life-threatening situations like:

  • Sepsis, leading to peritonitis: A ruptured spleen can lead to sepsis and finally to peritonitis. If the ruptured spleen is not treated on time, the chances of the patient collapsing from a massive internal hemorrhage go up. This is why it is vital that you seek emergency treatment if you fear your spleen or that of a loved one is ruptured.
  • Loss of blood, which in turn will impact the overall functioning of the body: The patient should start experiencing dizziness and lightheadedness upon rupturing the spleen. If left untreated, the patient may even collapse from massive internal blood loss.
  • Hypotension: The sudden drop in blood pressure due to massive internal bleeding can starve vital areas that require blood to function properly. So, if you are suffering from a ruptured spleen, you should also know that your blood pressure is quite low and you need to seek immediate medical assistance.

If untreated, a ruptured spleen may even cause death.