Rupture of Spleen and Its Complete Treatment.

by admin on July 30, 2009

ruptured-spleen-with-omentum

ruptured-spleen-with-omentum

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:

spleen is located just under your rib cage on your left side, important area for injury of spleen. With enough force, a blow to your abdomen — during a sporting mishap, a fist fight or a car accident can cause spleen rupture.

Haemorrhage behind the peritoneum, spine fractures and injury to kindney are seen along with rupture of spleen.

Injury by knife or some thing penetrating can also cause rupture of spleen, some times in some of diseases like malaria, spleen rupture spontaneously. Even some times in surgeries too splenic capsule can get torned.

Clinical presentation of Rupture of spleen.

Sever Haemorrhage and shock occurs due to rupture of spleenic vessels, death can occur with in few minutes, even in best controlled situations death cannot be delayed or prevented. Even patient recovers, slow developing haemorrhagic shock occurs.

on clinical examination you will see, that pallor will be present, tachycardia will be seen, definately patient will have low blood pressure, as patient going in haemorrhagic shock. You will notice coldness of extremities, and abdomen will be distended. Slowly and slowly patient will go towards paralitic ileus.

Kehr’s sign will be positive, as explained above.

Balance’s sign: Blood in the near by areas of spleen is fresh blood which will be coagulated and blood in periphery will not be coagulated, threfore, there will not be any shifting dullness present on left side of abdomen which can be seen on right side.

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

As you know that greater omentum is known as the policeman of abdomen, so it seals off  the tear which usually gets reopened after some lapse of time, along with this subcapsular haematoma gets ruptured.

If tail of pancrease is also injured, which causes release of pancreatic enzymes which digests the body tissues and further causing delayed shock.

Treatment of rupture of spleen:

Emergency Splenectomy: it is the prime choice and done in major of the cases, it is very easy to perform.

Tie splenic artery at upper border of pancrease, then tie the splenic vein. If conditions are very worse, just immobilize the spleen by sacrificing lieno renal ligament.



Partial Splenectomy: just understand fact, splenic artery gives upper polar and lower polar branches. Hence one of the branche is ligated, so that bleeding can stop and some part of spleen is removed, procedure known as partial splenectomy.

If patient is a child we can cut spleen into many pieces which are being implanted into omentum, due to property of neovasculariastion, vessels develop spleen survives and regains its functions.

Splenorrhaphy: here we try to preserve spleen, since the general condition of patent is good, here we tie the tear by using nonabsorable suture and put greater omentum which seals the tear perfectly.

Complications:  Sepsis after splenectomy, splenosis, haematemesis etc.

Image Credits Nazma.org

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{ 13 comments… read them below or add one }

Dr.faizan August 1, 2009 at 10:12 pm

Hello Doctor how are you. No khabar from you? Tried to contact on your number many times but your number is not working. Take care.

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admin August 3, 2009 at 10:23 am

well friend i will be calling you as soon as i get time, i was busy in exams, i have changed my mobile number

diamond rings August 2, 2009 at 10:44 pm

Great article, lots of intersting things to digest. Very informative

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Arsento August 3, 2009 at 5:40 am

Are you a professional journalist? You write very well.

Reply

admin August 3, 2009 at 10:23 am

i am not journalist i am a doctor

james richards November 4, 2009 at 5:52 am

on oct 20th i was admitted with a ruptured spleen and the flew me out to a trama center in tenn.and i spent 3 days in icu and 6 day in a private room in the trama unit they said it clotted up and it would be ok in 3 or so months.what i am curious about is am i in more danger than they are telling me? this rupture happened on its own and no one can tell me why.should i get a second oppinion? i feel just as bad as the day they let me go. I also want to ask if i’m at risk of Haemorrhagic Shock during my recovery? Cause we was looking this up on the enternet and was curiouse if maybe i need to be hospitalized again until i’am no longer at risk for Haemorrhagic Shock…if there is anyone out there that can help me or give me some answers its gladly thanked you can e-mail me atDANNY_RICHARDS74@HOTMAIL.COM THANK YOU HURTING IN KENTUCKY

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drvikram November 5, 2009 at 11:34 am

@james richards
Hi James Richard,

so sad to know that you suffered from spontaneous rupture of spleen, we saw your comment and providing you help related to your query

you are not in a more danger as told by doctor to you according to the informations given to us by you.

sometimes rupture of spleen occurs on its own due to malaria, infectious mononucleo, sarcoidosis, haemoltyic anaemia and laekumia.
Are u suffering from any of these diseases?

you are not at risk of haemorrhagic shock during the recovery.

There is no need to hospitalize right now and also no need to take second opinion, however you can do same for your satisfaction.

we can tell you whole picture of your illness but we need to see records, papers, investigations etc which were done during your illness period, if possible you can send us photocopy of your prescription letter, investigations, treatment records etc to us on this mail as reply to this mail, we will clearify you everything.

Get well soon

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sweety June 3, 2010 at 11:25 pm

thank u for nice informaton

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michele October 9, 2010 at 2:54 am

hi
my dad has just been to A&E with chest pains and shortness of breath he has now been told he has slight pneumonia and an extended liver and spleen …how common is this and what is the recovery rate of this

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admin October 9, 2010 at 1:09 pm

Hello Michele
as you said your father is having slight pneumonia, With treatment, most types of bacterial pneumonia treated within two to four weeks.Viral pneumonia may last longer, and mycoplasmal pneumonia may take four to six weeks to resolve completely. The final outcome of pneumonia depends on how ill the person is when he is first diagnosed, you can calculate the severity of pneumonia by pneumonia severity calculator and know its prognosis. He is also having hepatomegaly and spleenomegaly, further complicate it but no need to worry at this stage. But if you want complete case study of your dad, you can send me all reports and history+ x ray at our email address drvikram008@rediffmail.com we will provide you complete information.

michele October 15, 2010 at 1:02 am

@admin
hello, thankyou for you reply but my dad was found collapsed in the hospital room they tried to resucitate him for 12 mins but there was no response and died on 10th Oct they said it may of been a cardiac arrest, they were going to do tests on 11th Oct Doctor met with the coroner and decided the cause of death was Mastatic Lung Cancer hence the shadow on his lung, I cant understand how we never new this as he was a well man with a cough and dry throat he complained he had a niggly pain in hs back about a week ago the last time he went to see a G.P was Aug 2009 for a repeat prescription for blood pressure tablets.

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admin October 15, 2010 at 3:08 pm

We are extremely sorry to hear that, when lung cancer metastasis occurs to other organs, it is known as stage 4 where life expectancy comes to be less than one year.

kirbys April 8, 2013 at 11:05 pm

Several months ago my 12 yr old son had a bike injury and slightly ruptured his spleen. It clotted on it’s own and he was released and cleared of that injury. Today he has started hurting again, the same as he did on the day of injury. He has had bronchitis but no other injuries lately. Is there any chance his spleen opened back up after several months time? Any idea what else this could be?

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