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Splenic rupture

Last updated: July 29, 2021

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Injury to the spleen is most often the result of blunt abdominal trauma. In rare cases, it may also be caused by spontaneous rupture from an infection or a hematological condition. A ruptured spleen may result in massive intra-abdominal bleeding and should therefore be treated as a medical emergency. Rupture of the spleen may be acute or delayed: acute rupture, in which the patient immediately presents in severe pain and shock, is differentiated from a delayed rupture, which presents with sudden onset of pain and shock following a symptom-free interval lasting days to weeks. Depending on the severity of the injury, conservative therapy with observation in a high dependency unit may be considered, but most patients require surgical intervention. A splenic salvage maneuver (i.e., suturing, coagulation) is performed when possible; however, a splenectomy is commonly indicated in extensive injury involving the splenic hilum and may be a life-saving procedure.

Traumatic splenic rupture [1]

Atraumatic splenic rupture [2]

  • Anatomy
  • Mechanisms of splenic rupture
    • Acute rupture: injury of the splenic capsule and possibly the splenic parenchymal tissue → acute intra-abdominal bleeding
    • Delayed rupture: injury of the splenic parenchymal tissue in an initially intact splenic capsule → central or subcapsular hematomaasymptomatic interval (days to weeks) as hematoma distends inside the capsule → subsequent capsular rupture with intra-abdominal bleeding

References:[4]

It is important to identify signs of any other major life-threatening injury in a polytrauma patient! (see blunt abdominal trauma for details)References:[4]

Repeated ultrasound examination is crucial, especially in conservative management of splenic rupture!

  • In hemodynamically stable patients (or in unstable patients in which temporary stabilization with IV fluid resuscitation is successful)
  • Always consider other organs that could be injured (see “Differential diagnosis” below)

References:[4]

References:[5][6]

The differential diagnoses listed here are not exhaustive.

  • If low-grade injury in hemodynamically stable patients
  • If high-grade splenic injuries and/or hemodynamically unstable patients
    • Laparotomy
      • If only peripheral rupture: trial of splenic salvage – suturing, coagulation, or ligation of the injured blood vessel
        • Alternative: partial splenic resection
      • If hilar rupture: splenectomy
        • If necessary, reimplantation of splenic tissue
    • Alternative: consider angiographic embolization if patients are stable

Splenectomy is a life-saving procedure in cases of high-grade spleen rupture or continuous bleeding!References:[4][7][8]

Overwhelming post-splenectomy infection is a potenitally life-threatening complication!

References:[4][8]

We list the most important complications. The selection is not exhaustive.

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  2. Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Systematic review of atraumatic splenic rupture. Br J Surg. 2009; 96 (10): p.1114-1121. doi: 10.1002/bjs.6737 . | Open in Read by QxMD
  3. Dave A, Dhand H, Mujalde A. Spontaneous Rupture of Spleen During Pregnancy. The Journal of Obstetrics and Gynecology of India. 2012; 62 (6): p.692-693. doi: 10.1007/s13224-012-0141-0 . | Open in Read by QxMD
  4. Bjerke HS, Geibel J. Splenic rupture. Splenic rupture. New York, NY: WebMD. http://emedicine.medscape.com/article/432823-overview#a6. Updated: November 24, 2014. Accessed: December 5, 2016.
  5. Maung AA, Kaplan LJ. Management of splenic injury in the adult trauma patient. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/management-of-splenic-injury-in-the-adult-trauma-patient.Last updated: April 27, 2016. Accessed: December 5, 2016.
  6. Maung AA, Kaplan LJ. Surgical management of splenic injury in the adult trauma patient. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/surgical-management-of-splenic-injury-in-the-adult-trauma-patient?source=see_link#H21.Last updated: July 6, 2016. Accessed: December 5, 2016.
  7. Saxena AK, Grewal H. Pediatric Abdominal Trauma. Pediatric Abdominal Trauma. New York, NY: WebMD. http://emedicine.medscape.com/article/1984811-overview#a5. Updated: August 14, 2015. Accessed: December 5, 2016.
  8. Frost, JL. Children and Injuries. Lawyers and Judges ; 2001