Splenic injury usually results from blunt abdominal trauma.
Significant impact (eg, motor vehicle crash) can damage the spleen, as can penetrating trauma (eg, knife wound, gunshot wound). Splenic enlargement as a result of fulminant Epstein-Barr viral disease (infectious mononucleosis or posttransplant Epstein-Barr virus-mediated pseudolymphoma) predisposes to injury with minimal trauma or even spontaneously. Splenic injuries range from subcapsular hematomas and small capsular lacerations to deep parenchymal lacerations, crush injury, and avulsion from the pedicle.
The main immediate consequence is hemorrhage into the peritoneal cavity. The amount of hemorrhage may be small or large, depending on the nature and degree of injury. Many small lacerations, particularly in children, cease bleeding spontaneously. 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.
Symptoms and Signs
The manifestations of major hemorrhage, including hemorrhagic shock, abdominal pain, and distention, are usually clinically obvious. Lesser hemorrhage causes left upper quadrant abdominal pain, which sometimes radiates to the shoulder. Patients with unexplained left upper quadrant pain, particularly if there is evidence of hypovolemia or shock, should be asked about recent trauma.
The diagnosis is confirmed with CT in stable patients and with bedside (point of care) ultrasonography or exploratory laparotomy in unstable patients.
Treatment has traditionally been splenectomy. However, splenectomy should be 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. When surgery is needed, the spleen can be surgically repaired in a few cases, but splenectomy is still the main surgical treatment.
Last full review/revision June 2008 by Harry S. Jacob, MD