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.
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