Ruptured spleen

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Summary of Ruptured spleen

A splenic injury, which includes a ruptured spleen, can be caused by trauma. In minor injuries with little bleeding, there may be abdominal pain, tenderness in the epigastrium and pain in the left flank. Often there is a sharp pain in the left shoulder, known as Kehr's sign. Non-traumatic causes are less common and include infectious diseases, medical procedures such as colonoscopy, hematological diseases, medications, and pregnancy. In less than one percent of cases of infectious mononucleosis splenic rupture may occur.

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Ruptured spleen

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Chapter 58 Spleen Pathology Figure 58.1 A peripheral blood smear with erythrocytes containing Howell–Jolly bodies. Howell-Jolly bodies represent a damaged or absent spleen which has failed to ﬁlter these red blood cells. Figure 58.2 A peripheral blood smear containing target cells; erythrocytes that have become derformed and damaged, yet have not been cleared by an absent spleen. RUPTURED SPLEEN osms.it/ruptured-spleen PATHOLOGY & CAUSES ▪ Splenic rupture → break in splenic structural integrity → large amount of blood leaks into abdomen → shock → death CAUSES Traumatic ▪ Signiﬁcant force to spleen → rupture ▪ Blunt trauma to abdomen ▪ Penetrating trauma (e.g. gunshots/ stabwounds) Non-traumatic ▪ Splenomegaly → capsule thins, decreases structural integrity ▪ Infectious diseases ▫ Malaria, infectious mononucleosis ▪ Medical procedures ▫ Colonoscopy ▪ Hematological disease ▫ Non-Hodgkin’s lymphoma, acute lymphoblastic leukemia ▪ Malignancy ▫ Angiosarcoma ▪ Medications ▫ Anticoagulants ▪ Pregnancy ▪ Enlarged spleens more vulnerable to traumatic rupture SIGNS & SYMPTOMS ▪ Abdominal pain, epigastric tenderness, pain in left ﬂank ▪ Kehr’s sign ▫ Blood in peritoneal cavity → irritation of surrounding tissues → pain referred to tip of left shoulder ▪ Hypovolemic shock ▫ Tachycardia, hypotension, tachypnea, pallor, anxiety DIAGNOSIS DIAGNOSTIC IMAGING Emergency ultrasound ▪ Free blood in peritoneum OSMOSIS.ORG 453

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Ruptured spleen

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An intoxicated 50-year-old white male is brought to the emergency department after the car he was driving hit a telephone pole. He has a fracture of the femur, and is confused and uncooperative. His pulse rate is 120 beats/min, his blood pressure is 80/40 mmHg, and his skin is clammy. Initial physical examination of his abdomen does not indicate significant intra-abdominal injury. What is the next best step to determine the need for surgical management?

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