| Blunt splenic trauma | |
|---|---|
 Spleen ruptured by trauma | |
| Specialty | Hematologists |
Blunt splenic trauma occurs when a significant impact to the spleen from some outside source (i.e. automobile accident) damages or ruptures the spleen. Treatment varies depending on severity, but often consists of embolism or splenectomy. [1]
The primary symptom, hemorrhage, presents differently depending on the degree of injury, with the symptoms of major hemorrhage, shock, abdominal pain, and distention being clinically obvious. Minor hemorrhage often presents as upper left quadrant pain. Patients with unexplained left upper quadrant pain, particularly if there is evidence of hypovolemia or shock, are generally inquired regarding any recent trauma. [1]
The primary concern in any splenic trauma is internal hemorrhage, though the exact amount of hemorrhage may be small or large, depending on the nature and degree of injury. Small or minor injuries often heal spontaneously, especially in children. Larger injuries hemorrhage extensively, often causing hemorrhagic shock. A splenic hematoma sometimes ruptures, usually in the first few days, although rupture can occur from hours to even months after injury. [1]
Blunt splenic trauma most often occurs in automobile accident victims, in which it is a leading cause of internal bleeding. However, any type of major impact directed to the spleen may cause splenic trauma. This can happen in bicycling accidents, when the handlebar is forced into the left subcostal margin, and into the spleen. The degree of injury ranges from subcapsular hematoma, to splenic rupture. [1]
Diagnosis is confirmed with CT, or bedside ultrasound for less stable patients. Exploratory laparotomy is rarely used, though it may be of benefit in patients with particularly severe hemorrhage to assess for any retroperitoneal hematomas. An exploratory laparotomy is an opportunity to assess the four quadrants of the abdomen and to look at the bowel for any perforations, vascular injuries, or abnormalities. [2] A set of CT scan grading criteria was created to identify the need for intervention (surgery or embolization) in patients with splenic injury. The criteria were established using 20 CT scans from a database of hemodynamically stable patients with blunt splenic injury. These criteria were then validated in 56 consecutive patients retrospectively and appear to reliably predict the need for invasive management in patients with blunt injury to the spleen (sensitivity of 100%, specificity 88%, overall accuracy was 93%). [1] [3]
The study suggested that the following three CT findings correlate with the need for intervention:[ citation needed ]
Interactive tools have been developed that facilitate grading of splenic injury based on imaging findings.
Treatment has traditionally been splenectomy. Splenectomy involves ligation of three splenic attachments (splenorenal ligament, splenocolic ligament and splenophrenic ligament) to mobilize the spleen. The splenorenal ligament is located laterally, the splenocolic ligament inferiorly and the splenophrenic ligament superiorly. followed by suture ligation of the splenic blood supply. After the spleen has been removed, the abdomen is irrigated with normal saline to confirm hemostasis. After confirmation abdominal organs are put into anatomical position, followed by closure of the abdomen. [4] However, splenectomy is avoided if possible, particularly in children, to avoid the resulting permanent susceptibility to bacterial infections. Most small, and some moderate-sized lacerations in stable patients (particularly children) are managed with hospital observation and sometimes transfusion rather than surgery. Embolization, blocking off of the hemorrhaging vessels, is a newer and less invasive treatment. [3] When surgery is needed, the spleen can be surgically repaired in a few cases, but splenectomy is still the primary surgical treatment, and has the highest success rate of all treatments. [1]
The spleen is an organ found in almost all vertebrates. Similar in structure to a large lymph node, it acts primarily as a blood filter. The word spleen comes from Ancient Greek σπλήν (splḗn).
A splenectomy is the surgical procedure that partially or completely removes the spleen. The spleen is an important organ in regard to immunological function due to its ability to efficiently destroy encapsulated bacteria. Therefore, removal of the spleen runs the risk of overwhelming post-splenectomy infection, a medical emergency and rapidly fatal disease caused by the inability of the body's immune system to properly fight infection following splenectomy or asplenia.
Hemangiosarcoma is a rapidly growing, highly invasive variety of cancer that occurs almost exclusively in dogs, and only rarely in cats, horses, mice, or humans. It is a sarcoma arising from the lining of blood vessels; that is, blood-filled channels and spaces are commonly observed microscopically. A frequent cause of death is the rupturing of this tumor, causing the patient to rapidly bleed to death.
An injury is any physiological damage to living tissue caused by immediate physical stress. Injuries to humans can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or overexertion. Injuries can occur in any part of the body, and different symptoms are associated with different injuries.
Intracranial hemorrhage (ICH), also known as intracranial bleed, is bleeding within the skull. Subtypes are intracerebral bleeds, subarachnoid bleeds, epidural bleeds, and subdural bleeds.
A splenic injury, which includes a ruptured spleen, is any injury to the spleen. The rupture of a normal spleen can be caused by trauma, such as a traffic collision.
Blunt trauma, also known as blunt force trauma or non-penetrating trauma, describes a physical trauma due to a forceful impact without penetration of the body's surface. Blunt trauma stands in contrast with penetrating trauma, which occurs when an object pierces the skin, enters body tissue, and creates an open wound. Blunt trauma occurs due to direct physical trauma or impactful force to a body part. Such incidents often occur with road traffic collisions, assaults, and sports-related injuries, and are notably common among the elderly who experience falls.
A chest injury, also known as chest trauma, is any form of physical injury to the chest including the ribs, heart and lungs. Chest injuries account for 25% of all deaths from traumatic injury. Typically chest injuries are caused by blunt mechanisms such as direct, indirect, compression, contusion, deceleration, or blasts caused by motor vehicle collisions or penetrating mechanisms such as stabbings.
Splenic infarction is a condition in which blood flow supply to the spleen is compromised, leading to partial or complete infarction in the organ. Splenic infarction occurs when the splenic artery or one of its branches are occluded, for example by a blood clot.
Focused assessment with sonography in trauma is a rapid bedside ultrasound examination performed by surgeons, emergency physicians, and paramedics as a screening test for blood around the heart or abdominal organs (hemoperitoneum) after trauma. There is also the extended FAST (eFAST) which includes some additional ultrasound views to assess for pneumothorax.
Hemoperitoneum is the presence of blood in the peritoneal cavity. The blood accumulates in the space between the inner lining of the abdominal wall and the internal abdominal organs. Hemoperitoneum is generally classified as a surgical emergency; in most cases, urgent laparotomy is needed to identify and control the source of the bleeding. In selected cases, careful observation may be permissible. The abdominal cavity is highly distensible and may easily hold greater than five liters of blood, or more than the entire circulating blood volume for an average-sized individual. Therefore, large-scale or rapid blood loss into the abdomen will reliably induce hemorrhagic shock and, if untreated, may rapidly lead to death.
An accessory spleen is a small nodule of splenic tissue found apart from the main body of the spleen. Accessory spleens are found in approximately 10 percent of the population and are typically around 1 centimetre in diameter. They may resemble a lymph node or a small spleen. They form either by the result of developmental anomalies or trauma. They are medically significant in that they may result in interpretation errors in diagnostic imaging or continued symptoms after therapeutic splenectomy. Polysplenia is the presence of multiple accessory spleens rather than one normal spleen.
Penetrating trauma is an open wound injury that occurs when an object pierces the skin and enters a tissue of the body, creating a deep but relatively narrow entry wound. In contrast, a blunt or non-penetrating trauma may have some deep damage, but the overlying skin is not necessarily broken and the wound is still closed to the outside environment. The penetrating object may remain in the tissues, come back out the path it entered, or pass through the full thickness of the tissues and exit from another area.
Abdominal guarding is the tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them. The tensing is detected when the abdominal wall is pressed. Abdominal guarding is also known as 'défense musculaire'.
Abdominal trauma is an injury to the abdomen. Signs and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Complications may include blood loss and infection.
Diaphragmatic rupture is a tear of the diaphragm, the muscle across the bottom of the ribcage that plays a crucial role in breathing. Most commonly, acquired diaphragmatic tears result from physical trauma. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 0.5% of all people with trauma.
An exploratory laparotomy is a general surgical operation where the abdomen is opened and the abdominal organs are examined for injury or disease. It is the standard of care in various blunt and penetrating trauma situations in which there may be life-threatening internal injuries. It is also used in certain diagnostic situations, in which the operation is undertaken in search of a unifying cause for multiple signs and symptoms of disease, and in the staging of some cancers.
Splenosis is the result of spleen tissue breaking off the main organ and implanting at another site inside the body. This is called heterotopic autotransplantation of the spleen. It most commonly occurs as a result of traumatic splenic rupture or abdominal surgery. Depending on the location of the spleen, the new piece usually implants in another part of the abdominal cavity. Single case reports also describe splenosis in the thoracic cavity, in subcutaneous tissue, in the liver or in the cranial cavity. Splenosis must be distinguished from the presence of additional spleens, which are innate and are the result of differences in embryological development. Additionally, splenosis must be differentiated from malignant tumors which may look similar when imaged.
Spleen pain is a pain felt from the left upper quadrant of the abdomen or epigastrium where the human spleen is located or neighboring.
Adrenal hemorrhage (AH) is acute blood loss from a ruptured vessel of the adrenal glands above the kidneys.