Rupture of the Spleen
The spleen is an organ that can easily go for violent trauma to rupture affecting the abdomen or indirectly have an impact on it. Among all, the spleen is in fact the internal organ more frequently injured in the thoraco-abdominal trauma, because of its intrinsic fragility, of the rich vasculature, the presence of a long vascular pedicle (artery and vein lienale), and the connection to the various ligaments that transmit forces from other bodies.
The splenic lesions large extent become the rupture of the spleen in a true medical emergency that requires immediate surgery to stop internal bleeding and save the life of the patient. In case of multiple superficial injuries, a ruptured spleen can be treated conservatively, hospitalization for a few days the patient and observing the developments towards the possible spontaneous recovery.
Causes
In the introduction, we saw how the rupture of the spleen is common as a result of violent trauma affecting the abdomen, like a car accident, a serious fall, a punch during a fight or a penetrating wound (bullet, stab etc. .). The severe splenic injuries are also common in cases of violent falls from above, feet or buttocks, trauma to the abdomen while not directly affecting an impact on it.
Then there are the circumstances, not so rare, in which the spleen becomes particularly susceptible to breakage, even after modest or insignificant trauma, such as a cough, a sneeze, gags, stress on defecation, or a too vigorous palpation of the organ. In general, the risk of spontaneous breakage or secondary to trauma minimum is high in case of splenomegaly (enlarged spleen), especially if severe. Here, then, that the rupture of the spleen becomes more common during certain diseases, such as infectious mononucleosis, malaria, schistosomiasis, cirrhosis, hemolytic anemia (eg thalassemia), Gaucher's disease, sarcoidosis, leukemia hairy cell, chronic myelogenous leukemia, chronic lymphocytic leukemia, etc.. For this reason, in these individuals (eg. Children with infectious mononucleosis) the practice of contact sports or high risk of trauma is highly recommended by doctors.
Symptoms and Complications
The spleen is located in the upper left quadrant of the abdomen, just below the diaphragm, protected from the last ribs left hemithorax, under normal conditions the size of a fist. In the presence of a violent trauma of the abdomen, the patient complains of severe pain in this region (left hypochondrium, supero-lateral quadrant of the abdomen left), which radiates to the ipsilateral shoulder (left) and is aggravated by palpation. The abdominal walls are ipercontratte and the abdomen is distended by the accumulation of blood in the abdominal cavity, in addition the internal bleeding leads gradually to a state hemorrhagic shock, marked by symptoms such as paleness, anxiety, tachycardia, dizziness and confusion. Not always, however, the clinical manifestations of splenic rupture are established so early, the bleeding, then it may not be immediate but occur at a later time, with a latency of a few days after the trauma and late-onset disorders, even after 6-7 days after the accident.
Of course, the rupture of the spleen may be isolated or associated with lesions of other organs, complicating the clinical manifestations and prognosis, and when there was no association with lesions of other organs, splenic rupture mortality is high (10-20%), while in the case of isolated lesion mortality is around 4%.
Diagnosis and Treatment
The media are essential diagnostic CT and ultrasound, which corroborate the suspect emerged from the examination of a patient; peritoneal lavage has also an important diagnostic utility (we introduce a small catheter, a flexible plastic tube, abdomen , to extract and analyze the liquid sucked searching for the presence of blood).
Because of the important vascularization, rupture of the spleen can cause massive bleeding, with accumulation of blood in the abdominal cavity and the onset of hypovolemic shock until death. In such circumstances, the immediate surgical splenectomy (removal of the spleen) can be lifesaving for the patient without significant clinical complications.
Compared to the past, thanks to the appreciation of the role of the spleen and immune to the risk of severe post-operative infections, splenectomy surgery is now performed with greater caution. The doctors, in essence, tend to observe the patient to see if the bleeding is able to stop spontaneously, reserving the intervention to cases in which there is the spontaneous healing. Moreover, during surgery when one tries possible to repair the lesion, for example by applying sutures, or to remove only the part affected by the rupture of the spleen (splenectomy subtotal or partial).
