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 Rupture of Spleen and Its Complete Treatment.

 

Spleen is an anatomically small organ hidden under the 9th to 11th, dull note on percussion, measuring 1x3x5 inches and weighing about 7oz.

It lies in contact with diaphragm.

 

When blood collects due to splenic injury, it irritates the diaphragm causing referred pain to the shoulder tip. (kehr’s sign).

 

Causes of Rupture of spleen:

 

 1. Blunt injury of abdomen: injury to the left side of chest, left lower rib fracture, due to fall from a tree, road traffic accidents can be associated with splenic fracture.

Retroperitoneal haemorrahage, fracture spine and renal injury may be associated with splenic rupture.

Penetrating injuries to abdomen may cause rupture of spleen.

Spontaneous rupture of spleen is seen in malaria

splenic capsule can be torn during surgical procedures.

 

Clinical presentation of Rupture of spleen.

 

Tearing of splenic vessels can cause severe haemorrhage and shock , death can occur with in minutes, even in best situations death cannot be prevented.

 

A slow developing haemorrhagic shock followed by recovery.

 

Anaemia-pallor

Pulse- Tachycardia, more than 100/min

B. P low, cold clammy extremities, abdominal distension, paralytic ileus develops slowly.

Kehr’s sign is positive, as explained above.

Balance’s sign: Blood in the vicinity of spleen is fresh blood which is coagulated and blood in periphery is not coagulated, hence, there will not be shifting dullness on left side of abdomen but can be present on right side.

 

Saegesser’s splenic point of tenderness: it is an area of tenderness on left side between sternocleidomastoid and scalenus medius.

 

Greater omentum seals off a tear which get reopened after some time, a subcapsular haematoma also rupture after some time, associated injury to tail of pancrease causes release of enzymes, which digests the tissue,  at a later date, this is called as delayed type of shock.

 

Treatment of rupture of spleen:

 

Emergency Splenectomy: it is done in majority of  cases because its simple, easy and quick to perform, splenic artery is ligated first at upper border of pancrease followed by splenic vein. In poor conditions, the spleen is mobilized by cutting lieno-renal ligament.

 

Splenorrhaphy: it is a method of preservation of spleen when general condition is good, small tear is sutured by using chromic catgut and can be wrapped using greater omentum.

 

Partial Splenectomy: 

It is done because the splenic artery gives an upper polar branch and a lower polar branch which divides into 2 branches. Hence, one of the branches of splenic artery is ligated, the bleeding stops and a partial splenectomy can be done comfortably.

 

After splenectomy, spleen can be cut into multiple pieces and can be implanted with in greater omentum and because of neovascularisation, the spleen survives and functions like a spleen in production of antibodies, this can be done in children gives excellent results.

 

Complications of Splenectomy

Haematemesis, left basal collapse, post- splenectomy sepsis, splenosis.

 

Image Credits Nazma.org

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Abdominal surgery, Uncategorized Spleen, splenic rupture, surgery, surgery instruments