The spleen is an organ located in the upper left part of the abdomen, situated behind the ribs and just above the stomach. This fist-sized organ is part of the lymphatic system, playing a significant role in immune defenses. It functions primarily as a blood filter, removing old or damaged blood cells and producing white blood cells that help fight infection. While “bruised spleen” is a common term, it medically refers to a spleen contusion, an injury where small blood vessels within the organ break and leak blood into surrounding tissues. Its delicate structure and placement make it susceptible to damage from external forces.
Understanding Spleen Injury
Spleen injuries encompass a range of severities, extending beyond a simple contusion. These injuries can include lacerations, which are tears in the splenic tissue, or, in the most severe cases, a complete rupture of the organ. A rupture occurs when the spleen’s outer capsule tears or breaks, potentially leading to significant internal bleeding. The spleen’s rich blood supply and relatively fragile nature make it prone to damage.
Blunt force trauma to the abdomen is the most common cause of spleen injuries. This type of trauma frequently results from motor vehicle accidents, which account for a large percentage of severe cases. Other common mechanisms include falls, direct blows to the abdominal area during sports activities, or physical altercations. The spleen’s position under the lower left ribs, while offering some protection, still leaves it vulnerable to forceful impacts.
When the abdomen sustains a significant impact, the force can compress the spleen against the rigid rib cage or spinal column, leading to its injury. The organ’s soft, vascular tissue is less resilient to sudden, powerful external forces compared to other abdominal organs. Individuals with an enlarged spleen, such as from mononucleosis, are at an even higher risk of injury from less severe trauma.
Recognizing the Signs
Recognizing the signs of a spleen injury is important, though symptoms can vary depending on the injury’s severity. A common indicator is pain in the upper left abdomen, often accompanied by tenderness when the area is touched. This discomfort might also extend to the left side of the chest or under the left ribs.
A distinctive symptom is pain radiating to the left shoulder, known as Kehr’s sign. This referred pain happens because blood from an injured spleen can irritate the diaphragm, which shares nerve connections with the shoulder. The pain might worsen with deep breaths.
When internal bleeding is significant, more severe signs become apparent. These can include lightheadedness, dizziness, and a rapid heart rate, indicating blood loss. Low blood pressure, confusion, and paleness suggest substantial internal bleeding. Note that symptoms may not appear immediately after the injury, with some cases exhibiting a delayed presentation.
Medical Assessment and Care
Diagnosing a spleen injury begins with a physical examination, assessing the abdomen for tenderness and swelling. Blood tests may be conducted to check for signs of blood loss, such such as changes in hemoglobin levels or platelet counts, providing initial clues about internal bleeding. They help establish baseline values and monitor for ongoing blood loss.
Imaging studies are important for confirming a spleen injury and determining its severity. A Focused Assessment with Sonography for Trauma (FAST) ultrasound is used in emergency settings to quickly detect internal bleeding. For stable patients, a computed tomography (CT) scan with intravenous contrast is the preferred imaging method, as it provides detailed images of the spleen and identifies the type and grade of injury.
Treatment approaches for spleen injuries vary based on the injury’s grade and the patient’s overall condition. Less severe injuries, such as minor contusions or small lacerations, are managed conservatively. This non-operative approach involves close observation in the hospital, strict bed rest, and fluid replacement to support the patient’s stability. Many minor injuries can heal on their own with this management.
More severe injuries, particularly those involving significant or uncontrolled bleeding, may require surgical intervention. Surgical options include repairing the spleen (splenorrhaphy), or, in severe cases, removing part or all of the spleen (splenectomy). The decision for surgery is made when conservative management fails or if the patient’s condition becomes unstable due to continuous internal bleeding.
Recovery and Outlook
The recovery period following a spleen injury depends on its severity, but involves a period of rest and activity restriction. The spleen may take several weeks to three months to fully heal. During this time, activities that could put stress on the abdomen, such as heavy lifting, strenuous exercise, or contact sports, are avoided to prevent re-injury.
Follow-up care includes regular medical appointments and repeat imaging to ensure healing. A potential complication is delayed rupture, which can occur days or even weeks after the initial trauma, requiring continued vigilance. This can happen if a hematoma within the spleen expands and eventually breaks.
For individuals who undergo a splenectomy, there is a lifelong increased risk of infections, as the spleen plays a significant immune role. Vaccinations against specific bacteria are recommended to help mitigate this risk. It is important to seek immediate medical attention if new or worsening symptoms develop, such as increased abdominal pain, lightheadedness, or fever, as these could indicate a complication.