A Primer On Ruptured Spleens

Anatomy - Vital Organs: pancreas, duodenum, gallbladder, spleen and kidney. iStockphoto

Doctors say the spleen is the most commonly injured organ caused by blunt trauma to the abdomen. In sports, it can happen when players crash into each other, fly over their handlebars and land on their left side in a motocross wipeout, or take a hit to that part of the abdomen during a football tackle.

Diagnosis

Doctors say there are telltale signs that make them suspect a ruptured spleen:

  • Sustaining blunt force and feeling pain around the lower-left rib cage and upper-left abdomen
  • Having low blood pressure with a fast heart rate (a hint that blood isn't going where it should be)
  • Suffering fractures in the lower ribs
  • Demonstrating a "shoulder-strap" pain in the left shoulder due to blood from the spleen irritating the left diaphragm, which is the breathing muscle separating the abdomen from the chest. (This signal is called Kehr's Sign. It's a classic sign that may or may not show up when the spleen has been injured.)

    When a doctor suspects the spleen could be ruptured, an ultrasound or CT scan can provide more information about the injury site. A CT scan uses a computer to make detailed images of the injury. Doctors often will try to stabilize the patient with blood products, but if circulation cannot be controlled, surgery might be needed to correct the damage.

    Treatment

    A ruptured spleen is a serious injury because it can cause patients to bleed internally. If it is not corrected, it can be fatal. Doctors say that the severity of the injury is graded on a four-point scale, depending on how badly the organ has been bruised or torn. Sometimes the damage to the spleen and its blood vessels is so severe that the organ needs to be removed in order to control internal bleeding. But in cases that are not as severe, treatment can be managed non-operatively.

    Patients who have their ruptured spleen removed go on to recover from their injuries. The big downside, however, is that without a spleen, patients are much more susceptible to serious infections.

    Sources: David Gaieski, M.D., instructor in the department of emergency medicine, University of Pennsylvania, Philadelphia; fellow of the American College of Sports Medicine. Townsend: Sabiston Textbook of Surgery, 17th ed., 2004; pp. 523-525.

    By David Flegel, M.S.
    Reviewed by Louise Chang, M.D.
    © 2006, WebMD Inc. All rights reserved

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