Bleeding Spleen Terminology
The term for a bleeding spleen is splenic hemorrhage or splenic rupture when referring to traumatic bleeding, and hemoperitoneum when describing the resulting blood accumulation in the peritoneal cavity from splenic injury.
Clinical Context and Terminology
Splenic trauma encompasses the spectrum of bleeding injuries to the spleen, which are among the most frequent trauma-related injuries 1. The terminology varies based on the clinical presentation:
- Acute splenic hemorrhage: Active bleeding at the time of initial injury 1
- Delayed splenic hemorrhage: Bleeding occurring after a "free interval" following initial trauma, seen in 2-5% of splenic injuries 2
- Spontaneous splenic rupture: Non-traumatic bleeding, such as in infectious mononucleosis or underlying splenic pathology 3
Critical Clinical Distinctions
The distinction between immediate and delayed hemorrhage is clinically crucial because delayed bleeding can be occult, particularly in polytrauma patients where it may be "disguised" by the severity of the overall clinical picture 2. This delayed presentation historically was termed "delayed rupture of the spleen," though modern understanding recognizes most cases represent delayed diagnosis rather than truly delayed rupture 4.
High-Risk Factors for Delayed Hemorrhage
The following factors increase risk of delayed splenic bleeding 2:
- Severe trauma or polytrauma
- Age over 65 years
- Requirement of more than one blood unit for initial hemodynamic stabilization
Pathophysiologic Mechanisms
Splenic hemorrhage can result from several mechanisms 1:
- Subcapsular hematoma rupture: Blood accumulates under the splenic capsule and eventually ruptures
- Parenchymal laceration: Direct tearing of splenic tissue with vascular injury
- Pseudoaneurysm rupture: Post-traumatic vascular abnormality that subsequently bleeds 1
- Arteriovenous malformation: Rare non-traumatic cause of spontaneous hemorrhage 5
Clinical Significance
Massive hemorrhage commonly occurs from injuries to this friable vascular organ, with mortality from simple splenic rupture at 1%, but increasing to 10% with delayed diagnosis 4. The spleen's highly vascular nature and friable parenchyma make it particularly susceptible to life-threatening hemorrhage 1, 3.