17953 Ruptured Spleen

Overview

The spleen is a small organ on the left side of your belly, just under your ribs. It helps fight infection and filters old or damaged blood cells. A ruptured spleen means the spleen has been torn open, causing bleeding inside your abdomen. This is a medical emergency, because the bleeding can be heavy and life-threatening.

It is not very common, but the spleen is the most frequently injured organ in the abdomen after a serious accident.

It can happen to anyone, but it is most often seen in children, teenagers, and young adults. People who play contact sports, such as football or rugby, have a higher risk.

Symptoms

Common symptoms

• Pain in the upper left side of the belly
• Tenderness when you press on the belly
• Dizziness or light-headedness
• Weakness or confusion
• Blurry vision
• Pain in the left shoulder or left side of the neck
• Nausea or vomiting
• Feeling faint or passing out

Symptoms in children

• Clutching or guarding their belly
• Being unusually quiet or sleepy
• Pale or clammy skin
• Vomiting
• Acting dizzy or confused
• Breathing quickly

Symptoms in older adults

• Belly discomfort or pain that is not as sharp
• Confusion or sudden drowsiness
• Feeling weak or unsteady
• A fall that hit the belly or back
• Swelling in the belly

Causes

Main causes

• A strong blow to the belly, such as from a car accident, a fall, a sports injury, or a punch
• A medical condition that makes the spleen larger and easier to tear (for example, mono or liver disease)
• Very rarely, the spleen can rupture without any clear cause

Risk factors

• Playing contact sports
• Being involved in a car accident
• Having a fall or a direct hit to the belly
• Having an enlarged spleen
• Taking medicines that thin the blood (ask your doctor)

When to see a doctor

See a doctor urgently if:

• If you have been hit in the belly or had a fall, and you have belly pain, dizziness, shoulder pain, or nausea
• If you feel faint, have a fast heartbeat, or have severe abdominal pain
• Call your local emergency number right away if your symptoms are severe

Book a routine appointment if:

• If you have persistent belly pain without a clear cause, or you have pain that is getting worse
• If you have a health condition that can enlarge your spleen and you feel unwell

Diagnosis

A doctor will ask about your symptoms and what happened, and will examine your belly. If they suspect internal bleeding, they will use imaging tests to look at your spleen.

Tests that may be done

• Physical exam to check for tenderness and signs of bleeding
• Blood tests to check for blood loss
• CT scan (computed tomography) – a special X-ray that gives very detailed pictures
• Ultrasound – often used in an emergency to check quickly for fluid around the spleen

What to expect at your appointment

If doctors think you may have a ruptured spleen, you will need to go to a hospital. You will be monitored closely. If you are bleeding, you may get fluids and blood through a small tube in your arm. Depending on how bad it is, you may need surgery or just careful observation.

Treatment

Treatment depends on how much damage and bleeding there is. Some people with a mild injury to the spleen can be treated without surgery, just with rest and careful monitoring in the hospital. Others need a procedure to stop the bleeding. Doctors now try to keep the spleen in the body whenever it is safe.

Self-care at home

• Rest and avoid any heavy activity for at least several weeks, as your doctor advises
• Do not take medicines that prevent blood clotting or certain pain medicines unless your doctor says it is safe
• Go to all follow-up appointments so your healing can be checked

Medical treatments

In the hospital, you may receive fluids through an IV, a blood transfusion, and medicine to control pain while you heal. Some people need a procedure called angioembolization, where a doctor blocks the bleeding vessel with tiny particles. If there is very heavy bleeding, emergency surgery may be needed.

When is surgery considered?

Surgery is needed if the bleeding cannot be controlled or if the spleen is too badly injured. The surgeon may be able to repair the spleen. Sometimes the whole spleen has to be removed, which is called a splenectomy.

Living with this condition

If your spleen was repaired or left in, you can usually return to normal life after a few weeks of rest, though you should avoid contact sports for a while. If your spleen was removed, you can live an active life, but you will need to be extra careful about infections for the rest of your life. You will need to have several vaccines and, in some cases, take an antibiotic before certain dental or surgical procedures. Ask your doctor for your personal plan.

Lifestyle tips

• Wear a seatbelt every time you are in a car
• Use the right safety gear for sports, especially contact sports
• Avoid alcohol and tobacco while you heal
• Keep up to date with all recommended vaccines

Diet and exercise

Eat a healthy, balanced diet with fruit and vegetables to help your body recover. Start with gentle walks and slowly build up as your doctor allows. Do not lift heavy objects or run until your doctor says it is safe, usually about 6 to 8 weeks.

Mental health and emotional wellbeing

Having a serious injury can be scary. You might feel anxious, stressed, or low after treatment. That is normal. Talk to your doctor or a counselor if these feelings do not pass or get in the way of your daily life.

Prevention

You can lower your risk by wearing seatbelts, using safety gear in sports, and avoiding fights or high-risk activities. If you have an enlarged spleen, your doctor may advise you to avoid contact sports.

Vaccines

If your spleen has been removed or is not working well, you will need to be vaccinated against certain infections. Ask your doctor which vaccines you need and when.

Screening programmes

There is no routine screening test for a ruptured spleen. People with an enlarged spleen should see their doctor for follow-up, and may need imaging tests if they have symptoms.

Complications

If left untreated

• Heavy internal bleeding that can lead to shock
• Fluid or infection in the abdomen
• Damage to other organs from lack of blood
• Very rarely, death from blood loss

Long-term outlook

With prompt emergency care, most people recover fully. If your spleen is removed, you can live a healthy life by following your doctor's advice about vaccines and antibiotics. Your medical team will help you manage your health and protect you from infections.

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