Injuries to the spleen can be very malicious injury as they can pose an acute threat to the patient's life. In addition, they tend to be very insidious and asymptomatic in the beginning.
The spleen is an organ located in the abdominal cavity under the left costal arch. The organ is protected by the diaphragm and the ribs as it is quite fragile and richly supplied with blood.
Ruptured spleen may occur individually or as a part of extensive injuries, for example during car crashes. The spleen quite often becomes a victim of broken ribs that are originally supposed to protect it.
The injury may be blunt or accompanied with a direct perforation. Complete perforation of the spleen may cause bleeding into the abdominal cavity and quick development of a hemorrhagic shock. However, the rupture is usually only partial with intact splenic capsule. The blood may leak into the capsule and form a local hematoma. This situation is practically asymptomatic or it causes a mild abdominal pain located in the left upper quadrant. The bleeding may stop, but if it continues, the hematoma enlarges and the capsule may suddenly rupture as well. Again, there occurs an acute bleeding into the abdominal cavity with acute shock manifesting with rapid heart rate, low blood pressure, sweating, pallor, cold extremities and subsequently with a total cardiovascular collapse, unconsciousness and death.
A recent history of trauma and abdominal pain (no matter its intensity) are always warning signs. The blood tests may show anemia due to blood losses into the splenic capsule, but the blood count may be also totally normal. The most important examination is the abdominal ultrasound that can directly confirm the splenic injury, splenic bleeding, splenic hematoma and presence of blood in the abdominal cavity. Computed tomography is even better and we should prefer it as the first imaging examination method in patients with extensive injuries.
In cases, when there is only a small hematoma under the intact splenic capsule, we may proceed conservatively, but cautiously. The patient should obey total bed rest and regular monitoring by ultrasound is performed to confirm the gradual absorption and disappearance of the hematoma. Larger tear or rupture of the spleen and its capsule must be urgently treated by a surgical intervention. During the procedure, the organ may be treated by local administration of a special tissue glue to stop the bleeding or removed (partially or totally).