The spleen is an organ situated in the upper left part of the abdomen, tucked beneath the diaphragm and the lower ribcage. Its main job is to act as a specialized filter for the blood, removing old or damaged red blood cells and storing components like platelets and white blood cells that help the body fight infection. When the abdomen experiences a forceful impact, the spleen can be damaged. This damage is medically described as a contusion, similar to a deep bruise, and can range from minor surface damage to a complete rupture. An injury to this highly vascular organ can be serious because it may lead to significant internal bleeding.
Understanding Spleen Injuries
The medical description of a bruised spleen is categorized along a spectrum of injury severity. A splenic contusion represents the mildest form, involving bleeding and structural damage confined within the organ’s capsule. A hematoma is a related injury where a collection of blood forms either just under the capsule (subcapsular) or deeper within the spleen tissue (intraparenchymal). These injuries are systematically classified using the American Association for the Surgery of Trauma (AAST) Organ Injury Scale, which ranges from Grade I (minor contusion or small laceration) to Grade V (a completely shattered spleen).
The grade of injury directly correlates with the amount of structural damage and potential for ongoing hemorrhage. Lower-grade injuries (Grade I or II) typically involve small hematomas or shallow lacerations that often stop bleeding naturally. Higher-grade injuries (Grade IV or V) often involve deep lacerations, major blood vessel damage, or complete fragmentation, carrying a greater risk of life-threatening blood loss requiring urgent intervention.
Common Causes of Injury
The overwhelming majority of splenic injuries result from blunt trauma to the abdomen. This type of force can compress the spleen against the firm structures of the lower ribs or the spine, causing the organ to tear or bruise. Motor vehicle collisions are a frequent cause, especially when the abdomen sustains a direct impact against the dashboard or steering wheel. The sudden deceleration experienced in an accident can also cause a seatbelt to forcefully restrain the body, leading to internal abdominal injury.
High-impact sports, such as football, cycling, or skiing, also present a risk during forceful tackles or falls where the left flank is struck. Furthermore, falls from a significant height or direct blows to the left side of the torso can easily damage the organ. The spleen is somewhat protected by the lower ribs, but a blow strong enough to fracture these ribs often causes an underlying splenic injury.
Recognizing Signs and Symptoms
A person with a splenic injury will most commonly experience pain and tenderness in the upper left side of the abdomen, just under the ribs. The intensity of this abdominal pain can vary significantly depending on the extent of the damage and the amount of internal bleeding. The abdominal muscles in this area may feel rigid or tight to the touch as the body attempts to guard the injured organ.
A more specific sign of a splenic injury is referred pain felt in the left shoulder, known as Kehr’s sign. This sensation occurs because blood leaking from the spleen irritates the diaphragm, which shares nerve pathways with the nerves traveling to the shoulder. The pain may become more noticeable when the person is lying down or taking a deep breath.
When the spleen’s injury results in significant internal bleeding, a person may begin to show signs of hypovolemic shock. These signs indicate that the body is losing too much blood and are a medical emergency. Symptoms include:
- Feeling lightheaded
- A rapid heart rate (tachycardia)
- Low blood pressure
- Looking noticeably pale
- Confusion, blurred vision, or fainting
Medical Diagnosis and Management
Diagnosing a splenic injury begins with a physical examination and a review of the traumatic event that occurred. For stable patients, a computed tomography (CT) scan with intravenous contrast dye is the preferred imaging method to clearly visualize the extent of the damage and accurately assign an AAST grade. For trauma patients who are unstable and showing signs of shock, a focused assessment with sonography for trauma (FAST) ultrasound is used quickly at the bedside to check for free fluid, which is typically blood, in the abdomen.
Treatment for a splenic injury is determined primarily by the patient’s overall hemodynamic stability and the grade of the injury. For stable patients with low-grade injuries, non-operative management (NOM) is the standard of care, which involves strict bed rest and careful observation in the hospital. The goal of NOM is to allow the spleen to heal naturally, preserving its long-term immunological functions.
For high-grade injuries or for patients who become unstable despite resuscitation efforts, intervention is necessary. This may involve a procedure called transcatheter arterial embolization (TAE), where an interventional radiologist blocks the bleeding blood vessel to stop the hemorrhage and preserve the organ. If the bleeding cannot be controlled or the patient is profoundly unstable, a splenectomy (surgical removal of the spleen) may be performed as a life-saving measure.