From the Guidelines
Splenic rupture is a medical emergency characterized by bleeding from a damaged spleen, and its signs and symptoms include severe pain in the left upper abdomen, tenderness, abdominal rigidity, and signs of internal bleeding such as low blood pressure, rapid heart rate, and confusion, as reported in the World Journal of Emergency Surgery 1. The most common signs and symptoms of splenic rupture include:
- Severe pain in the left upper abdomen that may radiate to the left shoulder (Kehr's sign)
- Tenderness when touching the abdomen
- Abdominal rigidity or guarding
- Signs of internal bleeding such as low blood pressure, rapid heart rate, dizziness, lightheadedness, and confusion
- Nausea, vomiting, and extreme fatigue The severity of symptoms depends on the extent of the rupture and blood loss, and these symptoms typically develop after abdominal trauma, though spontaneous rupture can occur in enlarged spleens, as noted in the guidelines for adult and pediatric patients 1. The pain in the left shoulder occurs because blood irritates the diaphragm, which shares nerve pathways with the shoulder, and anyone experiencing these symptoms, especially after abdominal injury, should seek immediate medical attention as untreated splenic rupture can lead to life-threatening hemorrhage and shock, as emphasized in the management of splenic trauma patients 1. The choice of diagnostic technique at admission must be based on the hemodynamic status of the patient, and CT scan with intravenous contrast is the gold standard in hemodynamically stable or stabilized trauma patients, as recommended by the World Society of Emergency Surgery guidelines 1.
From the Research
Signs and Symptoms of Splenic Rupture
The signs and symptoms of splenic rupture can vary, but some common indicators include:
- Abdominal pain, which can be severe and may radiate to the left shoulder or back 2, 3, 4, 5
- Nausea and vomiting 2, 3
- Fever 2, 4
- Lethargy 2
- Respiratory distress 2
- Hemodynamic instability, such as hypotension or tachycardia 3, 6
- Clinical features of acute abdomen, such as tenderness or guarding 3
- Leukocytosis or acute anemia 3
Diagnostic Considerations
Diagnosing splenic rupture can be challenging, but certain diagnostic studies can help, including:
- Computed tomographic (CT) scan of the abdomen, which can demonstrate well-contained splenic laceration and subcapsular hematoma 3
- Ultrasonography, which can assist in the diagnosis of non-traumatic splenic rupture 5
- Peritoneal aspiration of fresh blood, which can confirm the presence of internal bleeding 5
Risk Factors and Etiology
Splenic rupture can occur due to various underlying pathologies, including: