What Is a Ruptured Spleen?

The spleen is a rich and brittle parenchymal organ. It is fixed behind the left upper abdomen by ligaments connected to its capsule, and is protected by the lower chest wall, abdominal wall, and diaphragm. Traumatic violence can easily rupture and cause internal bleeding. The spleen is the most easily damaged organ in the abdominal viscera, and its incidence accounts for almost 20% to 40% of various abdominal injuries. The spleen with pathological changes (portal hypertension, schistosomiasis, malaria, lymphoma, etc.) is easier The damage ruptured. Splenic rupture is divided into traumatic rupture and spontaneous rupture. Classification of splenic injury: Grade splenic subcapsular rupture or slight damage to the capsule and parenchyma. Splenic laceration was 5.0 and depth 1.0 cm during operation; Grade splenic laceration was> 5.0, depth> 1.0 cm, but spleen hilum Uninvolved, or spleen segment blood vessels involved; Grade III splenic rupture injury and spleen hilum or spleen separation, or spleen lobe blood vessel involvement; Grade IV spleen extensive rupture, or spleen pedicle, spleen arteriovenous trunk involvement.

Basic Information

English name

splenic rupture

Visiting department

surgical

Common locations

spleen

Common causes

The effects of external violence, such as a severe cough, sneezing or sudden posture change

Common symptoms

Left upper quadrant pain, worsening during deep breathing

Causes of splenic rupture

Traumatic rupture, caused by the effects of external violence.

Spontaneous rupture is caused by pathologically enlarged spleen due to severe coughing, sneezing or sudden change of body position.

Clinical manifestations of splenic rupture

The clinical manifestations of splenic rupture are mainly internal bleeding and blood-induced peritoneal irritation. The condition is closely related to the amount of bleeding and the rate of bleeding. Hemorrhagic volume is high and rapid, and hypovolemic shock soon appears, and the injury is critical; those with low bleeding volume and slow symptoms have mild symptoms, except for the left upper quadrant, which has no obvious signs and is not easy to diagnose. Over time, the amount of bleeding increased, and pre-shock manifestations followed by shock. Abdominal pain caused by the stimulation of the peritoneum by the blood began in the left upper abdomen and gradually involved the whole abdomen. It was still evident in the left upper abdomen. At the same time, there were tenderness, rebound pain and abdominal muscle tension in the abdomen. Sometimes the left shoulder involves pain due to blood irritation of the left diaphragm. The pain worsens during deep breathing. This is the Kehr sign. Laboratory tests revealed a progressive decrease in hematocrit, hemoglobin, and hematocrit, suggesting internal bleeding.

Splenic rupture examination

1. Type B ultrasound

This is a commonly used non-invasive test that shows a broken spleen, a large sub-enveloped hematoma, and hemorrhage in the abdominal cavity.

2.CT inspection

It can clearly show the spleen morphology, and is very accurate for diagnosing splenic parenchyma or subcapsular hematoma. At the same time, multiple organ injuries in the abdominal cavity can be found.

3. Nuclide scanning

The technique of diagnosing spleen injury using 99m 99 colloidal sulfur scan or gamma photography can be used. The method is safe and is not commonly used due to the limitation of the drugs required for the scan.

4. Selective abdominal angiography

This is an invasive inspection with complicated operations and certain risks. However, the diagnosis of spleen rupture is highly accurate, and it can show damaged arteries and parenchymal parts of the spleen. It is only used for closed injuries where the injury is stable and other methods have not been clearly diagnosed.

Diagnosis of splenic rupture

The diagnosis of traumatic spleen rupture is based on: history of trauma; clinical manifestations of internal bleeding; diagnostic puncture of abdominal cavity to extract non-coagulated blood.

In the case of splenic subcapsular laceration with subcapsular hematoma, the clinical manifestations are atypical and the abdominal puncture is negative, and the diagnosis is difficult to determine for the time being. For patients who have difficulty in diagnosis and whose injuries allow, use ultrasound, CT, radionuclide scanning, or selective abdominal angiography to help confirm the diagnosis.

The spleen rupture is often accompanied by other organ damage, such as liver, kidney, pancreas, stomach, intestine, etc. Do not omit during diagnosis and treatment.

Differential diagnosis of splenic rupture

Liver rupture: It accounts for 15% to 20% of various abdominal injuries. Right liver rupture is more common than left liver. The injury factors, pathological types, and clinical manifestations of liver rupture are very similar to spleen rupture. Liver and spleen rupture are mainly manifested by intra-abdominal hemorrhage and hemorrhagic shock. When the spleen is ruptured, the signs of peritoneal irritation caused by bloody peritonitis are not obvious. However, bile may enter the abdominal cavity after liver rupture. Therefore, abdominal pain and peritoneal irritation are often more pronounced than those of spleen rupture. After liver rupture, blood sometimes enters the duodenum through the bile ducts, and the patient develops melena or vomiting. Ultrasound and CT are the preferred methods to distinguish liver and spleen rupture.

Spleen Rupture Treatment

The principle of spleen rupture is mainly surgery. However, according to the degree of injury and the conditions at the time, different surgical methods should be used as much as possible to retain the spleen in whole or in part. small. The following surgical methods can be selected according to the specific situation of the injury:

Spleen repair

Suitable for splenic capsule laceration or linear splenic laceration. Slight injuries can be stopped with adhesive, and those who are not satisfied with the effect are repaired. The key step of the operation is to free the spleen sufficiently so that it can be lifted out of the incision, use non-invasive vascular forceps or fingers to control the blood flow of the spleen, and suture the active bleeding point with 1 ~ 0 thin sheep intestine or 3 ~ 0 silk Suture repair cracks. Needle eye bleeding after repair can be oppressed with hot saline gauze or applied with hemostatic agent until bleeding stops completely.

2. Partial splenectomy

It is suitable for repairing spleen tissue that is difficult to stop bleeding or loss of vitality, and more than half of the spleen parenchyma can be retained after partial splenectomy. Under the condition that the spleen is fully free and the spleen is controlled, the inactivated spleen tissue is removed, and the bleeding points are ligated or sutured respectively. The bleeding on the cut surface is applied with hemostatic agent and hot saline gauze until it stops completely. Omentum covered.

3. Total splenectomy

It is suitable for those with severely broken spleen or spleen pedicle not suitable for repair or partial splenectomy.

Preoperative preparation is of great significance to rescue patients with shock. Entering the right amount of blood or fluid can increase the tolerance of the wounded to anesthesia and surgery. If 600 to 800 milliliters of blood is quickly input, blood pressure and pulse still do not improve, suggesting that there is still active bleeding, and urgent cesarean control of the splenic pedicle should be performed during rapid blood transfusion. After controlling active bleeding, blood pressure and pulse can be improved quickly, creating conditions for further surgical treatment. In the case of difficult blood sources, blood can be collected in the abdominal cavity and filtered to return blood volume.