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.
Treatment
The
great majority of
adult patients require
surgical
intervention.
Splenectomy as a life saving procedure is still the standard
in
many cases.
Any questions be sent to drmmkapur@gmail.com
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