These symptoms show you a ruptured spleen

Synonyms

Ruptured spleen

introduction

A rupture of the spleen (technical term: rupture of the spleen) is an injury, usually a tear, within the spleen tissue. The most common cause of a ruptured spleen is blunt abdominal trauma, for example as a result of a serious traffic accident or a kick. Other typical accident mechanisms that often lead to the development of a ruptured spleen are falls on the handlebars of a bicycle or motorcycle, in which the spleen tissue is severely crushed. In patients who suffer from a so-called multiple trauma (multiple injuries, one of which or a combination of several injuries is potentially life-threatening) after an accident, the rupture of the spleen is usually considered an acutely life-threatening component. Spontaneous forms of rupture of the spleen, that is, forms not caused by trauma, are, however, rather rare. The spontaneous rupture of the spleen is usually caused by infectious diseases or various blood diseases (so-called hematogenous diseases), which lead to an enormous increase in the size of the organ.

From a medical point of view, the rupture of the spleen is divided into different degrees of severity. The easiest form of rupture of the spleen is a pure capsular rupture, in which there is no damage to the actual organ tissue. A typical symptom of a pure capsule rupture is the appearance of light oozing bleeding from the surrounding tissue (spleen parenchyma). The further classification depends on the extent of the severed capsule and parts of the parenchyma. In the most severe form of splenic rupture, the injuries reach so deep that important supplying blood vessels are also affected. The most suitable therapy in the presence of a ruptured spleen depends on the severity of the rupture. A pure capsule tear can usually be treated conservatively with close ultrasound control and observation of the circulatory parameters. In healthy people, the defect closes by itself within a few days as the blood clots. The functionality of the organ is usually completely preserved. As soon as the actual tissue (parenchyma) is affected, a purely conservative (non-surgical) treatment of the ruptured spleen is not considered effective. In the majority of cases, the tear in the spleen has to be treated surgically.

While the complete removal of the spleen was considered the method of first choice for many years, attempts are now being made to preserve the organ. For this reason, small defects are often closed with the help of special adhesives or covered with self-dissolving plastic nets. Partial removal of the organ (partial resection of the tissue affected by the ruptured spleen) is now considered a successful treatment method.

Symptoms

The symptoms of a ruptured spleen are in most cases quite classic, even if it is always difficult to recognize a ruptured spleen.
As a rule, a brief interview with the patient regarding the course of the accident provides an initial indication. In general, any blunt trauma affecting the left upper abdomen and / or left flank can be assumed to cause damage to the spleen with a nearly 90 percent chance.
Typical symptoms of a slight rupture of the spleen (for example a pure capsule rupture) with little bleeding include Pain in the left and / or middle upper abdomen.
Other symptoms that indicate the presence of a ruptured spleen are tenderness below the stomach (Epigastrium) and tapping pain in the area of ​​the left flank. Many of the affected patients also describe left-sided, breath-dependent symptoms as one of the typical symptoms in the presence of a ruptured spleen. In addition, there are radiations of pain that reach into the left shoulder (so-called "Sweeping sign“), One of the most common symptoms experienced by people with a ruptured spleen.

In addition, a ruptured spleen often causes severe irritation of the Diaphragm and des Phrenic nerve. As a result, some of those affected experience pain in the area of ​​the left side of the neck (so-called "Saegesser sign"). In general, it can be assumed that the severity of the symptoms correlate strongly with the extent of the parenchymal injury.
A rupture of the spleen of a higher degree shows itself in the majority of patients by heavy bleeding and clear symptoms of an impending one Volume depletion shocks.

These typical symptoms include:

• accelerated pulse rate (Tachycardia)
• low blood pressure (Hypotension)
• accelerated breathing (Tachypnea)
• possibly Hyperventilation
• cold sweat
• fear
• Restlessness

In addition, increasing clouding of consciousness is considered to be one of the most common symptoms in patients who develop volume deprivation shock caused by a ruptured spleen. The direct cause of this clouding of consciousness is an insufficient supply of the brain with oxygen. Furthermore, the representation of free fluid between the spleen and the left kidney in the so-called Koller pouch as a typical symptom of ruptured spleen. In addition, large bruises lying below the organ capsule (Hematomas) with the help of a Ultrasound examination represent. The externally invisible symptoms of a ruptured spleen, on the other hand, cannot be shown by taking an X-ray of the chest or by imaging the abdomen.

Further symptoms (or rather accompanying injuries) that may indicate the presence of a ruptured spleen are broken ribs in the area of ​​the lower left thorax. Visible bullet or puncture points in the left flank or the left upper abdomen can also be seen as an indication of a possible rupture of the spleen. If it is unclear whether the spleen tissue has been affected, a Computed Tomography of the abdomen (abdomen) be performed. A blood count can also reveal typical symptoms of a ruptured spleen. Since almost everything is in the Body circulation If blood has to pass through the spleen, a pronounced rupture of the spleen can lead to severe blood loss. In the laboratory examination, this is primarily expressed by a drastic decrease in the red blood pigment (hemoglobin; for short: Hb), the number of red blood cells (Erythrocytes) and the so-called "Hematocrit“(Volume fraction of cellular elements in the blood).

In addition, functional disorders of other organs are also considered to be common symptoms in the presence of a ruptured spleen. Especially the liver and the Kidneys react quite quickly to severe impairment of the spleen function. In the blood gas analysis, the affected patients usually show a decrease in the oxygen saturation of the remaining blood. In addition, in most cases, shock-induced hyperacidity of the blood (Acidosis) visible. The rapid increase in white blood cells (Leukocytes) in the blood count is one of the typical symptoms of a ruptured spleen.