Causative & risk factors
Any kind of blunt trauma to the abdomen can lead to splenic rupture. The causes of blunt trauma can include road traffic accidents, direct blow, sports injuries etc.
Certain disease conditions can cause the spleen to enlarge, thus the splenic capsule becomes thin. This makes the spleen more prone to rupture on account of any injury. These conditions include malaria, lymphomas, hemolytic anemia, infectious mononucleosis etc.
Sometimes rupture of the spleen can occur spontaneously, in absence of any underlying trauma or disease.
Clinical presentation
A ruptured spleen causes internal bleeding into the abdomen and usually gives rise to severe pain. The pain is usually felt in the left side of the abdomen. There may be referred pain at the left shoulder.
Also the blood pressure may drop down due to internal bleeding. This gives rise to symptoms of hypotension such as dizziness, blurring of vision and even shock.
Investigations
Rupture of the spleen is a medical emergency. Patient usually presents with history of trauma to the abdomen. A physical will reveal a distended and hardened abdomen. Patients with severe internal bleeding will have a low blood pressure. A CT scan, with or without contrast medium, is done to confirm the diagnosis. Those who cannot tolerate a CT scan are subjected to an MRI scan. A peritoneal lavage can be done to determine whether there is internal bleeding.
Treatment
All patients with a ruptured spleen need to be hospitalized.
If the splenic tear is minor, the patient is only monitored and the spleen is allowed to heal on its own. Small splenic tears can be repaired surgically. Arterial embolization is a good treatment option, but only if done immediately.
All patients with a severe splenic rupture must undergo surgery to remove the spleen (splenectomy). It is possible to survive without a spleen, however the patient may be prone to frequent infections.
