A spleen laceration is a serious injury where the tissue of the spleen is torn, most commonly as a result of blunt trauma to the abdomen. In Australia, this type of injury is frequently seen in car accidents, sporting incidents, and falls. Understanding the symptoms, diagnosis, and treatment options can make a critical difference in outcomes and recovery.
What Is a Spleen Laceration?
The spleen is located in the upper left side of the abdomen, just beneath the rib cage. A laceration means the spleen’s tissue has been cut or torn, which can lead to internal bleeding. The spleen is the most commonly injured organ in blunt abdominal trauma, making lacerations a significant concern in emergency medicine.
Causes of Spleen Laceration
- Blunt trauma: Car accidents, sports injuries, falls, or physical assaults.
- Penetrating injury: Less common, but can occur with stab wounds or gunshot injuries.
- Medical procedures: Rarely, procedures like colonoscopy can cause splenic injury.
Symptoms of a Spleen Laceration
The most common signs and symptoms include:
- Pain and tenderness in the upper left abdomen, sometimes radiating to the left shoulder (Kehr’s sign).
- Abdominal rigidity and muscle guarding.
- Signs of internal bleeding: Dizziness, light-headedness, confusion, blurred vision, or even loss of consciousness if blood loss is severe.
- Low blood pressure and rapid heartbeat in cases of significant hemorrhage.
If ribs on the left side are fractured, doctors are particularly vigilant for splenic injury, as these often occur together.
Diagnosis
- Physical examination: Doctors check for abdominal tenderness and signs of shock.
- Imaging: Ultrasound (FAST scan) or, more definitively, a CT scan with contrast is used to assess the spleen and grade the injury from I (minor) to V (severe).
- Emergency surgery: In cases of severe hemorrhage, immediate surgery may be required without waiting for imaging.
Grading Spleen Lacerations
The American Association for the Surgery of Trauma (AAST) grades spleen injuries as follows2:
| Grade | Description |
|---|---|
| I | Small laceration (<1 cm depth) or hematoma (<10% surface area) |
| II | Moderate laceration (<5 cm depth) or hematoma (10–50%) |
| III | Large laceration (>5 cm) or expanding hematoma (>50%) |
| IV | Laceration with partial devascularisation (>25%) |
| V | Shattered spleen or complete devascularisation |
Treatment in Australia
Non-Operative Management:
Most spleen lacerations, especially Grades I–III, can be managed without surgery if the patient is stable. This involves hospital monitoring, bed rest, and sometimes blood transfusions. Follow-up imaging may be used to track healing.
Surgical Management:
Surgery is required for severe injuries (Grades IV–V), ongoing bleeding, or if the patient is unstable. This may involve repairing the spleen or, more commonly, removing it entirely (splenectomy). After splenectomy, patients need vaccinations and long-term infection prevention, as they are at higher risk for certain infections.
Recovery and Long-Term Care
- Activity restriction: Light activity is recommended for the first several weeks, with gradual return to normal activities as healing progresses. Severe injuries may require months of restricted activity.
- Vaccinations: Essential for patients who have had their spleen removed, following Spleen Australia’s guidelines.
- Follow-up: Regular check-ups and, if needed, imaging to ensure proper healing.
When to Seek Emergency Help
If you experience severe left-sided abdominal pain, especially after trauma, or symptoms of shock (such as dizziness, confusion, or fainting), seek emergency medical care immediately. Early intervention can be life-saving.
Summary
Spleen laceration is a potentially life-threatening injury most often caused by blunt trauma. In Australia, management depends on the severity of the injury and the patient’s stability, with many cases successfully treated without surgery. Prompt diagnosis, careful monitoring, and appropriate follow-up are essential for the best outcome.