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Because of the spleen's position in the abdomen, a severe blow to the stomach area can damage the spleen, tearing its covering, the tissue inside, or both. The tears range from small ones that stop bleeding spontaneously to very large ones that cause potentially fatal hemorrhage. Sometimes a collection of blood (hematoma) forms under the covering of the spleen or deep within it.
Injury to the spleen is the most common serious complication of abdominal injury resulting from car crashes, falls from a height, athletic mishaps, and beatings. Sometimes other abdominal organs also are damaged.
When the spleen is injured, blood is released into the abdomen. The amount of bleeding depends on the size of the injury. A hematoma of the spleen may rupture in the first few days after injury, although rupture sometimes does not occur for months.
Symptoms
An injured or ruptured spleen makes the abdomen painful and tender. Blood in the abdomen acts as an irritant and causes pain. The pain is in the left side of the abdomen just below the rib cage. Sometimes the pain is felt in the left shoulder. The abdominal muscles contract reflexively and feel rigid. If enough blood leaks out, blood pressure falls and people feel light-headed, have blurred vision and confusion, and lose consciousness (fainting).
Diagnosis
Doctors usually do ultrasonography or computed tomography (CT) of the abdomen if they suspect an injury to the spleen. Rarely, if doctors suspect a severe hemorrhage, surgery is done immediately to make a diagnosis and control the bleeding. People with severe bleeding also are given intravenous fluids and sometimes blood transfusions.
Treatment
Doctors used to always remove a damaged spleen. However, removing the spleen can cause later problems, including an increased susceptibility to infections. Doctors now realize that most small and many moderate-sized injuries to the spleen can heal without surgery, although blood transfusions are sometimes required and people must be treated in the hospital. When surgery is necessary, usually the entire spleen is removed (splenectomy), but sometimes surgeons are able to repair a small tear.
After a splenectomy, certain precautions are needed to prevent infections (see Spleen Disorders: Overview of the Spleen).
Last full review/revision June 2008 by Harry S. Jacob, MD
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