RUPTURED SPLEEN

RUPTURE OF THE SPLEEN

Rupture of the spleen may occur as a consequence of blunt  injury

of the abdomen or a gunshot wounds.

The  spleen, alone or in combination with other viscera,  is  the

most  frequently  injured  organ following  blunt  trauma to  the

abdomen or the lower thoracic cage. Automobile accidents  provide

the  predominating cause, while falls, and blows incurred  during

contact sports are frequently implicated in children.

Clinical manifestations.

The  signs  and  symptoms produced by trauma to the  spleen  vary

according  to  the  severity  and  rapidity  of   intra-abdominal

hemorrhage. The majority of patients present with some degree  of

hypovolemia and techycardia is almost always present.

The  patient  usually complains of  generalized  upper  abdominal

pain,  which is one third of the cases is localized in  the  left

upper quadrant. Pain at the tip of the shoulder (Kehr's sign)  is

evidence of diaphragmatic irritation but occurs in less than half

the  patients.  If  the patient is placed  in  the  Trendelenburg

position, left shoulder pain may be produced.

Diagnostic Studies

Routine  abdominal  radiographs may  demonstrate  fractured  ribs

which:

1. Elevated immobile left diaphragm

2. An enlarged splenic shadow

3. Medial displacement of the gastric shadow with

4  Widening  of the space between the  splenic  flexure  and  the   

   proportional   fat  pad.  Abdominal  paracentesis   yields   a   

   positive tap.
5 Abdominal CT scan

Treatment

The   great   majority  of  adult   patients   require   surgical

intervention.

Splenectomy  as a life saving procedure is still the  standard  in

many cases.

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