Makindo Medical Notes

Increased risk of Splenic Rupture with splenomegaly due to conditions such as infectious mononucleosis, liver disease, infiltrative diseases, and malignancy.

About

• The spleen lies below the ribcage and is a commonly affected organ in blunt abdominal injuries across all age groups.
• Injuries are commonly associated with motor vehicle accidents, domestic violence, sports injuries, and bicycle handlebar accidents.
• Early detection of splenic injury is crucial for effective management and to prevent complications such as hemorrhagic shock.

Aetiology

• The spleen weighs approximately 75-150 grams and is a highly vascular organ, making it vulnerable to injury.
• It filters an estimated 10-15% of the total blood volume every minute, playing a key role in immune surveillance and RBC storage.
• The spleen can pool large volumes of red blood cells (RBCs) and platelets, which contributes to its ability to respond to injury but also increases bleeding risk.

Clinical Presentation

• Signs of shock including hypotension (low BP), tachycardia, and evidence of hypovolemic shock.
• Left upper quadrant (LUQ) pain and tenderness, often accompanied by abdominal guarding.
• Referred pain to the left shoulder (Kehr's sign), which is indicative of diaphragmatic irritation from blood in the peritoneal cavity.
• Symptoms of splenic injury can sometimes be delayed, so ongoing observation and serial clinical assessments are important.
• Ensure a full trauma evaluation to identify potential associated injuries (e.g., rib fractures, liver injuries).

Investigations

• Blood Tests: Full blood count (FBC), Urea and electrolytes (U&E), Liver function tests (LFTs), and cross-matching for potential blood transfusion.
• Chest X-ray (CXR): To assess for associated injuries like rib fractures, diaphragmatic perforation, pleural effusion, or haemothorax.
• Ultrasound (USS): May be used to detect splenic haematomas or free fluid in the abdomen (FAST scan in trauma).
• CT Abdomen: The imaging modality of choice, providing a detailed view of the spleen to assess for lacerations, hematomas, or splenic rupture.

Management

• ABCDE: Prioritize airway, breathing, circulation, disability, and exposure. Begin with IV fluids for resuscitation if the patient is in shock.
• Trauma Assessment: A full trauma assessment, including other injuries, is essential for guiding management.
• Reversal of Anticoagulation: Consider reversing any anticoagulant therapy (e.g., warfarin, DOACs) or treating coagulopathies to reduce bleeding risk.
• Surgical Intervention: Emergency splenectomy may be required in cases of severe or uncontrollable bleeding. Small splenic tears can be repaired conservatively in some cases (e.g., via splenic artery embolization).
• Post-Splenectomy Care: Lifelong protection is needed against infections, especially encapsulated organisms. Vaccination (e.g., pneumococcal, Haemophilus influenzae type b, meningococcal) and prophylactic antibiotics may be required.