Rupture of the spleen
A rupture of the spleen, also called rupture, is an injury to the spleen. This occurs most often as a result of a blunt abdominal trauma (for example in a car accident), less often as a result of spontaneous rupture due to illness.
The spleen is used to secrete red blood cells, store and multiply white blood cells and is therefore a very well-perfused organ. The treatment of choice is therefore often surgery, as otherwise the patient may bleed to death. In rare exceptions, a ruptured spleen can also be treated conservatively.
A distinction is made between the causes traumatic from not traumatic events. The spleen is actually well protected on the left under the last Ribs, under the diaphragm and above the left kidney. Thus, it usually takes more serious accidents to injure the spleen.
Usually this happens through Car, motorcycle or bicycle accidents in which, for example, the bicycle handlebar is pressed into the abdomen. Rarely can too broken ribs be the cause that can pierce the spleen or injury from a Surgery in the abdomen.
Just as rare are non-traumatic causes like that Tearing of the spleen due to diseasessuch as the Pfeiffer's glandular fever (M.ononucleosis) or cancer. Usually, however, a rupture of the spleen is only one in diseases very strong enlargement of the organ possible and therefore predictable.
Ruptured spleen from sneezing
A ruptured spleen (Ruptured spleen) can generally occur due to severe trauma such as accidents with a bicycle or car.
If the spleen is previously damaged, it can spontaneously tear. Sneezing causes (intra-abdominal) generates a higher pressure, which in principle can have a damaging effect on the organs located there.
In order for this increase in pressure to have such a damaging effect on the spleen that it ruptures due to sneezing, the spleen usually has to be previously damaged. This previous damage can be caused by a virus such as Pfeiffer's glandular fever (Eppstein-Barr virus, EBV) to be triggered. This disease is characterized, among other things, by an enlarged spleen (Splenomegaly) out. With this enlargement of the spleen, the spleen capsule in particular is very tight and stressed. In this case, spontaneous rupture of the spleen and its capsule can also occur. Of course, in this tense state, the spleen tears even more easily if there is an increase in pressure, for example due to strong sneezing.
Another reason for a swelling of the spleen and thereby an increased risk of a ruptured spleen can be a blood clot in the large hepatic vein (Portal vein thrombosis) be. Through this clot, the blood backs up into the spleen, which then swells; here too, the sudden increase in pressure in the abdomen caused by the sneeze can lead to a rupture of the spleen. This type of rupture of the spleen caused by sneezing is rather rare and is immediately noticed by severe pain. This pain is often located in the upper abdomen and is aggravated by pressure.
In general, tearing of the spleen caused only by sneezing is very rare, and even with a previously damaged spleen, a little more pressure is usually necessary to make it tear. Of course, the increased likelihood of a ruptured spleen due to sneezing is also decisive in terms of the degree of previous damage. The more the spleen is swollen and the more tight the capsule is, the easier it is for the spleen to rupture due to natural sudden increases in pressure such as sneezing. Smaller capsular tears and minor splenic tissue injuries are more common than complete ruptures of the vessels supplying the spleen.
If, after a strong sneeze with a known severely damaged spleen, new severe pain occurs, a doctor should be consulted so that this can be performed by ultrasound (Sonography) can rule out a rupture of the spleen.
Generally speaking, a ruptured spleen caused by sneezing is a very rare complication.
There are altogether five different shapes of the ruptured spleen. This is due to the anatomy of the spleen. It is surrounded by a protective capsule.
- Grade 1: The Capsule has ruptured, bleeding occurs, but it is small and will not get bigger
- Grade 2: The The capsule and the spleen tissue are injuredHowever, the bleeding is not particularly severe as only smaller blood vessels are involved.
- Grade 3: Capsule, spleen tissue and larger vessels are affected.
- Grade 4: Capsule, spleen tissue and the great afferent vessels are injured
- Grade 5: Spleen is completely torn out and thus no longer supplied with blood.
If you just tear the capsule, they are Bleeding not particularly bad. Tear the Capsule and tissue the spleen, the injury is much worse. From grade 3 to grade 5, conservative therapy is no longer sufficient, it has to be operated on as quickly as possible become.
Symptoms vary depending on the shape of the ruptured spleen.
If only the capsule is affected, there are often no symptoms at first.
However, if the internal bleeding is not stopped, symptoms of anemia can occur, which means that the patient can feel weak and tired, can no longer concentrate properly and it can also lead to dizziness and confusion. If blood accumulates in the abdomen during prolonged bleeding, this can lead to abdominal pain, as well as pain in the shoulder and neck area, which is due to irritation of nerves.
With larger accumulations of blood it comes to the defense tension in the abdomen, the abdomen becomes hard what in medicine is also called "board-hard" stomach. If not only the capsule is affected, but also the tissue itself, the symptoms are more severe. The patient then complains of severe pain in the abdominal area, as well as shock (circulatory collapse) with a rapid heartbeat, low blood pressure and rapid breathing which, if left untreated, leads to a clouding of consciousness and, in the worst case, death.
Read more on the topic: These symptoms show you a ruptured spleen
If a rupture of the spleen is suspected, an ultrasound (Sonography) made from the abdomen; the ultrasound can also quickly and safely rule out minor bleeding from the spleen and major capsular bleeding. Computed tomography can also be performed in patients with low suspicion of a ruptured spleen and in good general condition.
The advantage here is that the computed tomography can also show minor injuries to the spleen and the capsule, which is sometimes difficult with ultrasound.
Blood tests in the laboratory can provide an indication of anemia, but are not a diagnostic substitute for a ruptured spleen.
Read more on the topic: Ultrasound of the abdomen
Therapy depends on the severity of the ruptured spleen. Over a long period of time, the organ had to be completely surgically removed even if the spleen was not severely torn (Splenectomy). However, due to the risks and consequences that this surgical procedure brings with it for the affected patient, attempts are now being made to operate preferably to preserve organs. In the case of tears in the capsule (grade 1 spleen tear) and minor bleeding, it is often sufficient to check the spleen and the bleeding by ultrasound and to wait, i.e. to carry out conservative treatment. Relief of pain and prevention of infections are paramount for the affected patients. In addition, care must be taken to ensure that any loss of blood and / or fluid is promptly compensated for with infusions. However, close-knit ultrasound checks must be carried out throughout the therapy. In addition, the circulatory parameters (especially pulse and blood pressure) and the blood count of the patient concerned should be checked regularly. In particular, the common inflammation parameters (leukocytes, C-reactive protein and sedimentation rate) and the number of individual blood cells play a decisive role in this context. Complications can only rarely be observed with a 1st degree ruptured spleen and adequate therapy. The bleeding is often stopped by the body's blood clotting.
A 2nd or 3rd degree rupture of the spleen (in these cases there is no violation of the vascular style) should, if possible, be operated on to preserve the spleen.
Surgical treatment of the ruptured spleen is carried out in the affected patient using infrared or electrocoagulation. In this procedure, infrared rays or alternating current with a particularly high frequency are used to close the affected tissue and prevent bleeding. The use of a special fibrin glue can also help stop the bleeding that occurs when the spleen ruptures.
In the case of a fourth degree rupture of the spleen (this results in an injury or rupture of the vascular style), at least a small, functional part of the organ can often be preserved.
However, a 5th degree rupture of the spleen (this results in a complete interruption of the blood supply to the spleen) usually has to be treated by a complete removal of the spleen (splenectomy). In addition, the age of the affected patient also plays a role in choosing the most suitable therapy method.
While organ-preserving surgery is attempted by all means in children and adolescents, a spleen removal is primarily an option for older patients. The reason for this is the fact that the complication rate during and after the operation is significantly lower in adults. In addition, unfavorable anatomical conditions can mean that complete removal must be preferred to organ preservation. This is especially the case with very overweight patients (obesity). The prognosis of a ruptured spleen depends primarily on blood loss, the accompanying injuries, the age of the patient and the therapy chosen. If a suitable therapy is initiated promptly, the prognosis of a minor rupture of the spleen is very good.
One of the most feared complications after removal of the spleen is the so-called OPSI, a disease that can occur in the event of a bacterial infection after removal of the spleen. To avoid this complication, children are vaccinated before the planned splenic removal or the patients are treated with antibiotics.
OP of a ruptured spleen
With a ruptured spleen (Ruptured spleen) it is important to begin with Bleeding into the abdomen to stop and since the spleen is an organ with very good blood circulation, quick and targeted action is necessary.
Different surgical procedures are used depending on where the spleen is torn. With a ruptured spleen (Ruptured spleen) on the edges of the spleen (Spleen periphery) one always tries to preserve the remaining tissue. Maintaining the spleen is particularly important in children, as these are important tasks of the Immune system takes over. If the spleen is now torn at the edges, an attempt is made to sew over the spleen.
Another method is fibrin bonding, which is where it works fibrin, which also plays an important role in wound healing as an endogenous substance, as a kind of tissue adhesive.
You can also stop the bleeding from the torn area by pinching off the artery supplying that area (Segmental artery ligature). The bleeding can also be caused by squeezing (compression) the spleen with a so-called Vicryl mesh being stopped. If the removal of a spleen segment (partial splenectomy) is necessary, this can be done with a laser be performed.
Is the rupture of the spleen (Ruptured spleen) at the point where the vessels enter and exit the spleen (M.ilzhilus) or if the spleen is damaged too much by the tear, it is usually one complete removal the spleen necessary (Splenectomy). Since this operation is very often an emergency operation, the abdomen is central opened (median laparotomy) and the spleen from diaphragm solved. Here, too, it is important that the vessels that supply the spleen are clamped.
If the spleen is removed or, in the case of smaller tears in the spleen, it is adequately supplied, as described above, the source of bleeding into the abdominal cavity has also been eliminated.
It can also become too during the operation Complications such as increased blood loss caused by the administration of blood reserves (Blood transfusion) needs to be balanced. As with any operation, there is also a risk here Wound healing disorder and the Rebleeding.
Especially with the complete removal of the spleen there is an increased risk of Blood poisoning (sepsis). Therefore, at Children under 6 years always trying to preserve part of the spleen. To reduce the risk of blood poisoning, vaccinations are usually given after the spleen has been removed, especially against the so-called Pneumococci. Pneumococci are bacteria. As after other operations, preventive therapy is used to avoid the formation of Blood clots (Thrombosis prophylaxis) began.
Consequences of a ruptured spleen
In some cases, surgical intervention can effectively treat a ruptured spleen and preserve the organ. At a complicated rupture of the spleen however, the organ must in some patients completely removed become. The removal of the spleen A ruptured spleen can have serious consequences for the organism. For this reason, the decision to remove the spleen is now rather cautious, even in the case of a complicated rupture of the spleen.
Especially when children and adolescents are affected by a ruptured spleen determined after the organ removal Precautions be seized. Because the spleen in relation to the body immune system The consequences of a complicated ruptured spleen can play a crucial role Sustainable influence on the immune system. For this reason, affected patients must expect a lifelong increased risk of serious bacterial infections to get sick.
Above all, a significant increase in the risk of training a Blood poisoning (Technical term: sepsis) is one of the most important consequences of a complicated ruptured spleen. In addition, there is a demonstrably increased risk of an affected patient Meningitis (Technical term: meningitis) to get sick.
The restriction of the body's immune defense caused by the removal of the spleen and the associated consequences are described in the so-called "overwhelming postsplenectomy infection / OPSI“Syndrome in summary. This immunodeficiency can have serious consequences, especially in children between the ages of 1 and 5, who have to have a spleen removed after a complicated rupture of the spleen. Besides the Development of important immune cells, the spleen also plays in relation to the Blood clotting a crucial role. If the organ has to be removed in the course of a complicated ruptured spleen, this can be a increased tendency to develop blood clots entail. This phenomenon in turn calls for a significant increase in the emergence of a Portal vein thrombosis (Thrombosis in the hepatic vein), one Heart attack and / or one Stroke emerged.
However, these consequences of a ruptured spleen can be prevented. Especially with children and adolescents, special emphasis should be placed on the regular intake of penicillin be placed. Antibiotic treatment can help severe bacterial infections to prevent.
If one of the affected children has a Penicillin allergy before so must other active ingredients become.
In addition, if possible, patients should have a spleen removed extensively vaccinated become. In this context, the most important Vaccination against pneumococci (Pneumonia pathogen), Meningococci (Meningitis causative agent) and Haemophilus influenzae (Pathogens causing pneumonia, croup, meningitis and joint inflammation) play a crucial role.
In addition, patients after a complicated ruptured spleen with complete removal of the organ should be examined by a doctor at regular intervals. Only through these measures can the most serious consequences of a ruptured spleen be prevented.
Ruptured spleen in children
It is particularly important in children who have ruptured the spleen to preserve the organ if possible. Although the spleen because of its anatomical location under the costal arch is relatively well protected from the effects of force, children in particular can develop a rupture of the spleen during an accident. Injury to the spleen in children often leads to internal bleeding and one The blood drains into the abdomen.
Strong pain in the field of left flank, dizziness, a headache and fatigue are typical symptoms of a ruptured spleen in children.
In children in particular, a lack of hemostasis can quickly lead to one Circulatory collapse or to Death by bleeding to death to lead. For this reason, in the presence of a ruptured spleen, treatment mainly involved the complete removal of the affected organ. As a result, it often occurs in children pronounced weakening of the immune system and the associated recurrent infections.
Especially the training of one life-threatening blood poisoning (sepsis) or one Meningitis (meningitis) are particularly feared after the spleen has been removed. In addition, blood clotting in children is negatively affected after removal of the spleen. In children who are affected by a ruptured spleen, attempts are therefore now made to preserve the organ or parts of the organ that are in good working order. The prerequisite for this, however, is that the bleeding can be stopped successfully and that there is no threat to life.
Ruptured spleen during pregnancy
Even during the pregnancy can it in the course of a blunt trauma the development of a ruptured spleen. Due to the injury to the organ, it usually occurs tremendous bleedingthat move into the abdomen.
These accumulations of blood can enormously restrict the space inside the abdomen and thus cause complications.
In addition, if the spleen ruptures during pregnancy, it must be noted that the bleeding may be more pronounced due to the increased blood volume.
Despite the significantly increased blood volume during pregnancy, even a slight loss of blood in the event of a ruptured spleen can have a strong impact on the condition of the expectant mother.
The reason for this is the fact that large amounts of the red blood cells transported oxygen over the placenta passed on to the unborn child.
The mother's oxygen saturation can therefore drop significantly if the spleen ruptures during pregnancy.
If a ruptured spleen occurs during pregnancy, it must be treated as soon as possible. Otherwise, a life-threatening condition can arise for both the unborn child and the mother.