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Ruptured spleen
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
A ruptured spleen is a serious condition that can occur when your spleen experiences a trauma. Without emergency treatment, a ruptured spleen can cause life-threatening bleeding.
Your spleen is located just under your rib cage on your left side, a prime spot for injury. With enough force, a blow to your abdomen — during a sporting mishap, a fist fight or a car accident, for example — might lead to a ruptured spleen.
In the past, ruptured spleens usually were removed in emergency surgery. These days, however, it's common for people with ruptured spleens to be treated instead with several days of hospital care to help the spleen heal.
Symptoms
The spleen helps your body fight infection and filter unwanted material, such as old or damaged blood cells. The spleen also produces red blood cells and certain types of white blood cells. A ruptured spleen may pour a large amount of blood into your abdominal cavity.
Abdominal pain and tenderness are the classic symptoms of a ruptured spleen. If internal bleeding causes your blood pressure to drop, you may become lightheaded or confused. Blurred vision and fainting are possible as well.
When to see a doctor
A ruptured spleen is a medical emergency. If you have pain in the left upper abdomen or signs and symptoms of low blood pressure — such as lightheadedness, confusion, blurred vision or fainting — following an injury, seek emergency medical care.
Causes
A ruptured spleen is typically caused by a blow to the left upper abdomen or the left lower chest. Sporting mishaps, fist fights and car accidents are common triggers. An injured spleen may rupture soon after the abdominal trauma or, in some cases, days or even weeks after the injury.
An enlarged spleen — which may be caused by various underlying problems, from mononucleosis and other infections to liver disease and blood cancers — may sometimes rupture with trauma to the abdomen. In fact, a ruptured spleen is the most significant complication of mononucleosis.
Complications
A ruptured spleen can cause life-threatening bleeding into your abdominal cavity.
Tests and diagnosis
In a critical situation, a physical exam may be the only diagnostic test before emergency surgery. In other cases, a sample of fluid from your abdomen may be tested for the presence of blood. If time allows, your doctor may use CT scans or other imaging tests to identify or rule out other possible causes of your symptoms.
Treatments and drugs
Many small and many moderate-sized injuries to the spleen can heal without surgery. You're likely to stay in the hospital for up to a week while doctors observe your condition and provide nonsurgical care, such as blood transfusions, if necessary. If your injury is severe, your spleen may need to be surgically repaired or, in some cases, removed. Surgery to remove your spleen is called splenectomy.
Many splenectomies are done with a small incision and a slender tube equipped with a camera lens and light (laparoscope), but emergency surgery may require an open procedure. If you've lost a large amount of blood, you may need transfusions to improve your circulation.
Life without a spleen
You can live an active life without a spleen, but you're more likely to contract serious or even life-threatening infections. If your spleen is removed, your doctor may recommend a pneumonia vaccine, as well as yearly flu vaccines. In some cases, preventive antibiotics may be recommended as well — especially if you have any other conditions that increase your risk of serious infections.
After a splenectomy, notify your doctor at the first sign of an infection. Make sure anyone caring for you knows that you've had your spleen removed.
- Laparoscopic spleen removal (splenectomy). The Society of American Gastrointestinal and Laparoscopic Surgeons. http://www.sages.org/sagespublication.php?doc=PI12. Accessed Sept. 21, 2008.
- Spleen injury. The Merck Manuals Medical Online Library: Home Edition for Patients and Caregivers. http://www.merck.com/mmhe/sec14/ch179/ch179c.html. Accessed Sept. 21, 2008.
- Mononucleosis. American Academy of Family Physicians. http://familydoctor.org/online/famdocen/home/common/infections/common/viral/077.html. Accessed Sept. 21, 2008.
- Splenectomy. American Academy of Family Physicians. http://familydoctor.org/online/famdocen/home/articles/655.printerview.html. Accessed Sept. 21, 2008.
- Indications for splenectomy. National Guideline Clearinghouse. http://www.guideline.gov/summary/summary.aspx?doc_id=5505. Accessed Sept. 21, 2008.
