Splenic Rupture
⚠️ Splenic rupture is a life-threatening emergency. Risk is highest in splenomegaly (e.g. infectious mononucleosis, haematological malignancy, liver disease, infiltrative disorders).
📌 About
- 🩸 The spleen is the most commonly injured solid organ in blunt abdominal trauma.
- 🚗 Common causes: road traffic collisions, sports injuries, bicycle handlebar accidents, falls, domestic violence.
- ⏱️ Early recognition is vital to prevent haemorrhagic shock.
🧬 Aetiology
- ⚡ Highly vascular organ (75–150 g) filtering 10–15% of blood volume per minute.
- 🧪 Acts as a reservoir for RBCs and platelets → increased bleeding risk if ruptured.
- 🌍 Spontaneous rupture can occur with splenomegaly (EBV, malaria, haematological malignancies).
👩⚕️ Clinical Presentation
- 🚨 Signs of shock: tachycardia, hypotension, pallor, cold peripheries.
- 🤕 Left upper quadrant (LUQ) pain and tenderness with guarding.
- 💡 Kehr’s sign: referred pain to left shoulder from diaphragmatic irritation.
- ⏳ Symptoms may be delayed → serial assessment is essential.
- 🔎 Always assess for associated injuries (rib fractures, liver injuries, diaphragm rupture).
🔍 Investigations
- 🧪 Bloods: FBC, U&E, LFTs, clotting, crossmatch for transfusion.
- 🫁 Chest X-ray: rib fractures, diaphragmatic injury, haemothorax.
- 🖥️ FAST ultrasound: rapid detection of intra-abdominal free fluid.
- 📸 CT abdomen (gold standard): defines laceration, haematoma, active bleeding.
🛠️ Management
- 🧑⚕️ ABCDE approach: airway, breathing, circulation; secure large-bore IV access; resuscitate with fluids/blood.
- 💊 Reverse anticoagulation if on warfarin/DOACs or correct coagulopathy.
- 👀 Conservative: stable patients with minor tears → observation or splenic artery embolisation.
- 🔪 Surgery: unstable or uncontrolled bleeding → splenectomy (definitive) or splenic repair (splenorrhaphy).
- 🛡️ Post-splenectomy: vaccinate (pneumococcal, Hib, meningococcal), consider prophylactic antibiotics, educate patient about lifelong risk of overwhelming sepsis (OPSI).
