What Is Ruptured Spleen?

You may have heard it being said in films and series, or maybe from someone you know, that a ruptured spleen needs to be surgically removed. Maybe you have even asked yourself, how can they remove an entire organ from the body without severe consequences? Why do doctors not fix it or replace it with another one, like they do in kidney transplants, for example? Well, sometimes things happen unpredictably.

The importance of the spleen

The spleen is a small organ (about the size of an avocado) located inside the left rib cage, above the stomach. It is a part of the lymphatic system, which is involved with ensuring the proper functioning of the immune system.¹

It consists of two types of tissue:

• White pulp: This tissue produces white blood cells, which make antibodies to fight infections.  This is why the spleen is important for the functioning of the immune system.
• Red pulp: This tissue is more like a filter. It removes waste from the blood and any damaged red blood cells. It also helps to destroy viruses and bacteria.

The spleen also stores blood and maintains the level of fluid in the body.

A ruptured spleen

A ruptured spleen occurs when there is damage or a break in the spleen’s surface. The spleen is the most easily injured of the abdominal organs. A ruptured spleen is considered a medical emergency because the spleen bleeds easily.²

Ruptured spleen causes

A ruptured spleen can occur as a result of traumatic or non-traumatic causes.^2,3 

Traumatic causes

• These are the most common causes of splenic rupture. The traumas come in different forms, including car accidents (the most common cause, which is responsible for 50-75% of ruptured spleens), sports injuries (mostly in contact sports like hockey), violence (e.g., stabbings, fist blows, and gunshot wounds).
• The spleen might rupture immediately after the contact or it might have a delayed rupture. Delayed ruptures become apparent after days or weeks because of the swelling from the injury.

Non-traumatic or spontaneous causes

• This type is rare and happens due to an underlying condition that causes the spleen to swell because of the accumulation of the blood cells in it. Another name for this is enlarged spleen. 
• The most common cause of an enlarged spleen is a viral infection called mononucleosis, which spreads through saliva. Other causes include syphilis (a bacterial infection), malaria (a parasitic infection), lymphoma (a cancer affecting immune cells), and chronic inflammatory diseases like hepatitis and pancreatitis.
• It has been noticed that a ruptured spleen can be a complication following colonoscopies. Although it is rare, specialists say that there might be a suspicion of splenic rupture in patients presenting with abdominal pain after colonoscopy.⁴

Ruptured spleen signs and symptoms

A ruptured spleen presents with a distinct pain in the upper left quadrant of the abdomen at the moment of the rupture. After that, the pain will likely transmit to the left side of the chest and the left shoulder, which is known as Kehr’s sign. Kehr’s sign happens because the bleeding can irritate the nerve that runs from the neck down through the left side of the chest. This pain might increase when breathing as well.^2,5

Other symptoms include but are not limited to

• Pain in the upper left part or under the rib cage of the abdomen
• Tenderness when touching the upper left part of the abdomen
• Symptoms resulting from the bleeding, especially when it is extensive: dropping blood pressure, lightheadedness, nausea, blurred vision, confusion or disorientation, dizziness, signs of hemorrhagic shock like paleness and faintness, tachycardia, rapid breathing, and anxiety

Ruptured spleen diagnosis

There are several tests and procedures to diagnose splenic rupture:⁶

• Checking for blood in the abdomen cavity. In emergency cases, the healthcare team either uses an ultrasound or draws a sample of fluid from the stomach with a needle. If there is blood in this sample, it may indicate the need for emergency surgery.
• Physical exams. In this procedure, the healthcare provider will press on the abdomen to check the spleen focusing on whether it is tender when touched and determining its size.
• Blood tests are used to evaluate the platelet count and the likelihood/state of blood clotting.
• Imaging tests for the stomach. When the diagnosis is not evident from the tests above, a CT scan or other imaging tools might be applied to the stomach.

Differential diagnoses

There are other conditions that have similar characteristics to splenic rupture and may be diagnosed in its place:⁷

• Abdominal compartment syndrome
• Acetabular pelvic fractures
• Liver, genitourinary or ureteral trauma
• Diaphragm injury
• Retroperitoneal hemorrhage
• Open book or straddle pelvic fracture

Ruptured spleen treatment and management

The treatment of a splenic rupture depends on the severity and aetiology of the rupture.⁷ Additionally, the hemodynamic stability of the patient will play a role.

Non-operative treatment

In order to preserve the function of the spleen, especially in paediatrics (children), options that do not require surgery are attempted in 60-90% of patients with blunt traumatic splenic injuries.

Interventional radiology

• This method is used to perform arterial embolisation for small or large vessel injuries with bleeding in stable patients.
• Embolisation helps manage the bleeding instead of or prior to surgery. It is a a non-surgical procedure in which they use radiology imaging techniques to guide the catheter into the vessel and inject tiny beads to stop the bleeding.²

Operative treatment

If hemodynamic instability continues, or if the patient needs more than four units of blood within a 48-hour period, then a laparotomy is required (where a large incision is made in the abdominal wall to access the abdominal cavity). This is used to get a better understanding of the situation at hand and judge the next steps of treatment.  

• The initial preference in surgical management is splenorrhaphy (repairing capsular lacerations).
• If the bleeding stays uncontrolled, then a splenectomy is needed, which would involve removing part of the spleen or all of it. About 20% of splenic rupture cases require a splenectomy.²

Ruptured spleen prevention

If a person is diagnosed with a ruptured spleen or is worried about the potential of it happening, they must ask a healthcare provider what they could have avoided or should do to protect their spleen. For example, avoiding certain contact sports, heavy lifting, and any other activities that might expose them to any type of abdominal trauma.⁶ However, accidents are uncontrollable and seeking medical advice from a professional immediately after injury will increase the chances of a better outcome.  

FAQs

What is the survival rate of individuals who rupture their spleen?

It is estimated that the mortality rate in non-traumatic ruptured spleens is 12.2%. In a traumatic ruptured spleen, it depends on the nature and severity of the trauma.⁸

What is the ruptured spleen recovery time?

It may take about 3 to12 weeks to recover, depending on the extent of the injury and the treatment.² When surgical interventions take place, the incision will also need to heal and avoid infection. A scar will likely remain where the surgery took place.  

How long can you live with a ruptured spleen?

It depends on the severity of the internal bleeding. While a small rupture causes a low amount of bleeding, which can give the patient some time, severe bleeding is very dangerous and might cause death within hours if it is not treated immediately.²

Why is it necessary to remove a ruptured spleen in some cases?

A splenectomy is necessary when the ruptured spleen causes unmanageable, severe internal bleeding because this is life-threatening.⁹

Can you live a normal life after a splenectomy?

You can live without a spleen. However, your immune system will be weaker, and you will be at greater risk of infection since the spleen plays a critical role in your immunity. The degree of this risk depends on your age and overall health.¹⁰

Is it possible to transplant a spleen?

Yes, it is possible, and there have been many studies on this.¹¹

Summary

In conclusion, we must not neglect our health and any signs or symptoms of splenic rupture. Some incidents could be extremely dangerous and might cost us our lives if we ignore them. Being aware of what a ruptured spleen is, its symptoms, and treatment options increases the likelihood of treatment reaching those in need sooner.