Section 14. Blood Disorders

Chapter 179. Spleen Disorders

Topics: Introduction | Enlarged Spleen | Ruptured Spleen

Ruptured Spleen

Because of the spleen's position in the abdomen, a severe blow to the stomach area can rupture the spleen, tearing its covering and the tissue inside. A ruptured spleen is the most common serious complication of abdominal injury resulting from car accidents, athletic mishaps, and beatings.

When the spleen ruptures, a large volume of blood may pour out into the abdomen. The spleen's tough outer covering may contain the bleeding temporarily, but surgery is needed immediately to prevent life-threatening blood loss.

Symptoms

A ruptured spleen makes the abdomen painful and tender. Blood in the abdomen acts as an irritant and causes pain; the abdominal muscles contract reflexively and feel rigid. If the blood leaks out gradually, no symptoms may occur until the body's blood supply is so depleted that blood pressure falls and not enough oxygen can reach the brain and heart. Symptoms of low blood pressure and lack of oxygen include light-headedness, blurred vision, confusion, and loss of consciousness (fainting). Such a situation is an emergency requiring immediate blood transfusions to maintain adequate circulation and surgery to stop the leak; without these actions, the person could go into shock and die.

Diagnosis and Treatment

X-rays of the abdomen are taken to determine if the symptoms may be caused by something other than a ruptured spleen. Scanning procedures using radioactive material to trace blood flow and find leaks may be performed, or fluid in the abdomen may be withdrawn by a needle and tested to see if it contains blood. When doctors strongly suspect that the spleen has ruptured, the person is rushed to surgery to stop the potentially fatal loss of blood. Usually the entire spleen is removed (splenectomy), but sometimes surgeons are able to repair a small rupture.

Before and after a splenectomy, certain precautions are needed to prevent infections. For example, vaccinations against pneumococcus are given before a splenectomy whenever possible, and yearly vaccinations against influenza are recommended after a splenectomy. Under some circumstances, antibiotics are recommended to prevent infections, particularly when the person has another condition (such as a sickle-cell disease or cancer) that increases the risk of developing life-threatening infections.