The spleen, located in the upper left abdomen, is part of the lymphatic system. It filters blood by removing old or damaged red blood cells and produces white blood cells to fight infection. Spleen injuries do not always present immediate or obvious symptoms, often leading to a delayed onset of serious issues.
Understanding Spleen Injury
Spleen injuries commonly result from blunt trauma to the abdomen, such as car accidents, falls, or contact sports. While its location under the left rib cage offers some protection, the spleen’s delicate structure and rich blood supply make it susceptible to damage from forceful blows. Injuries can range from minor tears to a complete rupture.
Not all spleen injuries are immediately life-threatening; some may initially be minor, such as a small tear or a contained collection of blood. These minor injuries might not cause immediate, noticeable symptoms, allowing a period where the individual feels relatively well. This initial stability can mask the underlying damage, setting the stage for symptoms to appear hours, days, or even weeks later as the injury evolves.
Key Delayed Symptoms
A person with a spleen injury that initially went unnoticed may later develop a range of symptoms as the condition worsens. Left upper abdominal pain is a common symptom, often described as a dull, aching sensation that persists and gradually intensifies over time. This pain is felt just below the left rib cage.
Another indicator is referred pain to the left shoulder, known as Kehr’s sign. This occurs because internal bleeding from the spleen can irritate the diaphragm, a muscle located near the spleen, and the pain signals travel along shared nerve pathways to the shoulder. This shoulder pain often intensifies when lying flat or with leg elevation, and may lessen when sitting upright.
Systemic signs of internal bleeding may also emerge, including lightheadedness, dizziness, or even fainting. These symptoms are linked to a reduction in blood volume and a subsequent drop in blood pressure. A rapid heart rate and shortness of breath can also occur as the body attempts to compensate for blood loss and reduced oxygen delivery.
Pale or cold, clammy skin are additional signs of significant blood loss and the body’s response to shock. Nausea and vomiting can signal general internal distress. The abdomen might also become tender to the touch or noticeably swollen, indicating internal bleeding or inflammation around the injured spleen.
Why Symptoms Emerge Later
The delay in symptom onset following a spleen injury can be attributed to several physiological factors. Initially, bleeding from a splenic injury might be slow and contained within the spleen’s outer capsule. This containment can prevent immediate widespread irritation of surrounding tissues or a rapid drop in blood pressure.
Over time, this contained bleeding can gradually accumulate, forming a hematoma (a collection of blood) under the splenic capsule. This hematoma may then expand, increasing pressure within the spleen, or it might rupture days or even weeks later due to increased internal pressure or minor re-trauma. This delayed rupture then releases blood into the abdominal cavity, causing the sudden onset or worsening of symptoms.
Another contributing factor can be a gradual inflammatory response to the internal injury. The body’s reaction to damaged tissue and escaped blood can take time to develop into noticeable discomfort or systemic signs. Some initial injuries might also be subtle, making them difficult to detect without advanced imaging, and only become apparent as they progress or complications arise.
When to Seek Immediate Medical Care
Any suspicion of a spleen injury, particularly if delayed symptoms arise, warrants immediate medical attention. Seek immediate medical care by contacting emergency services or proceeding to the nearest emergency room. Prompt diagnosis and treatment are important to prevent severe complications, such as hemorrhagic shock from significant blood loss, or peritonitis, an infection of the abdominal lining.
Medical evaluation involves a thorough physical examination, where healthcare providers assess for tenderness or rigidity in the abdomen. Imaging tests, such as an ultrasound or a computed tomography (CT) scan, are used to confirm the diagnosis and determine the extent of the injury. A CT scan with contrast is a detailed imaging method for assessing splenic injuries. Depending on the severity of the injury, treatment approaches can range from close observation in a hospital setting to surgical repair or, in some cases, removal of the spleen.