A ruptured spleen is a serious medical emergency that requires immediate attention. The spleen, located in the upper left abdomen beneath the ribs, plays a vital role in filtering blood and supporting the immune system. Due to its position and delicate structure, it is the most commonly injured organ in abdominal trauma. In Australia, awareness of spleen rupture symptoms and timely treatment can be life-saving.
What Causes a Spleen Rupture?
The most frequent cause of spleen rupture is blunt abdominal trauma, often resulting from:
- Motor vehicle accidents
- Falls from heights
- Sports injuries
- Physical assaults
In some cases, the spleen may rupture spontaneously without significant trauma, especially if it is enlarged due to infections (like glandular fever), blood disorders, or cancers.
Recognizing the Symptoms
Symptoms of a ruptured spleen can vary but often include:
- Severe pain in the upper left abdomen, which may radiate to the left shoulder (known as Kehr’s sign), worsened by breathing in deeply
- Tenderness and rigidity in the abdomen
- Signs of internal bleeding and shock, such as lightheadedness, dizziness, fainting, rapid heartbeat, pale skin, confusion, and weakness
- Nausea and restlessness
Because the spleen is highly vascular, a rupture can lead to significant internal bleeding, causing a rapid drop in blood pressure and life-threatening complications.
How Is a Ruptured Spleen Diagnosed in Australia?
If a ruptured spleen is suspected, especially after trauma, Australian healthcare providers follow a systematic approach:
- Physical Examination: Checking for abdominal tenderness, rigidity, and signs of shock.
- Focused Assessment with Sonography for Trauma (FAST) Ultrasound: A bedside ultrasound to quickly detect internal bleeding.
- Computed Tomography (CT) Scan: Provides detailed imaging to assess the extent of spleen injury and grade it from I (minor) to V (severe).
- Blood Tests: To evaluate blood loss and overall stability.
Treatment Options
Treatment depends on the severity of the rupture and the patient’s stability:
- Non-surgical management: For patients who are hemodynamically stable with low-grade injuries (I–II), close monitoring in a hospital setting with bed rest, blood transfusions if needed, and serial imaging may be sufficient.
- Surgical intervention: Patients with ongoing bleeding, high-grade injuries (IV–V), or unstable vital signs usually require surgery. The most common procedure is a splenectomy (removal of the spleen), although in some cases, surgeons may attempt to repair the spleen.
- Post-surgery care: After spleen removal, patients are at increased risk of serious infections. Vaccinations against pneumococcus, meningococcus, and Haemophilus influenzae type b are recommended, along with possible antibiotic prophylaxis.
Important Considerations for Australians
- The spleen is more vulnerable if enlarged due to infections like infectious mononucleosis, making rupture possible even with minor trauma.
- Left lower rib fractures can be a clue to underlying splenic injury; up to 20% of such fractures are associated with spleen damage.
- Children’s flexible rib cages may mask rib fractures, so careful assessment is crucial after trauma.
- Early recognition and treatment improve outcomes significantly.
When to Seek Emergency Help
If you or someone else experiences severe left upper abdominal pain after trauma, dizziness, fainting, or signs of shock, call emergency services immediately. Prompt medical evaluation can be lifesaving.
Summary
Spleen rupture is a critical condition often caused by blunt trauma but can also occur spontaneously in certain diseases. Australians should be aware of symptoms like severe left abdominal pain and shoulder pain, along with signs of internal bleeding. Diagnosis involves physical exams, imaging, and blood tests, while treatment ranges from careful observation to urgent surgery. Post-treatment care is essential to prevent infections after spleen removal.