Spleen rupture

Spleen rupture is usually the result of blunt abdominal trauma.

The increase in the spleen as a result of fulminant infection caused by the Epstein-Barr virus (infectious mononucleosis or posttransplantation pseudolymphoma) predisposes to rupture from minimal trauma or even spontaneous rupture. A significant impact (for example, a car accident) can lead to the rupture of even a normal spleen.

Symptoms of rupture of the spleen

The rupture of the capsule of the spleen results in significant bleeding into the abdominal cavity. Common clinical manifestations include hemorrhagic shock, abdominal pain and bloating. Injury to the spleen can lead to a sub-capsular hematoma, which may not rupture for several hours or even months after the injury.

The rupture is usually preceded by pain in the area of the upper quadrant of the abdomen. Spleen rupture should be suspected in patients with blunt abdominal trauma and hemorrhagic shock or pain in the area of the upper left quadrant of the abdomen (which sometimes radiates to the shoulder); patients with unexplained pain in the area of the upper left quadrant of the abdomen, especially if there are signs of hypovolemic shock, should be interviewed about a possible trauma. The diagnosis is confirmed by CT scan (in stable patients), ultrasound or peritoneal lavage (in unstable patients).

Treatment of rupture of the spleen

Treatment of rupture of the spleen has traditionally been a splenectomy. However, splenectomy should be avoided whenever possible, especially in children due to a constant increased susceptibility to bacterial infections in the future. In these cases, transfusion therapy is necessary.