The spleen is a small, fist-sized organ situated in the upper left part of the abdomen, nestled just beneath the rib cage. It serves a dual function, primarily filtering the blood to remove old or damaged red blood cells while also playing a significant role in the immune system by helping the body fight off infection. The organ is encased in a thin, protective capsule, and a rupture occurs when this capsule tears, spilling the spleen’s contents into the abdominal cavity. This type of injury is most often caused by a powerful, blunt force trauma, such as a severe blow to the torso from a car accident, a hard fall, or a contact sports injury.
Identifying the Signs of a Ruptured Spleen
The most immediate sensation associated with a ruptured spleen is typically a sharp, intense pain localized to the upper left abdomen. This pain can range in severity, sometimes being immediately debilitating, or it can be a persistent, deep ache that worsens over time. The area may also feel tender or painful when lightly touched or pressed, a finding known as guarding.
A particularly specific symptom is referred pain felt in the left shoulder, which clinicians call Kehr’s sign. This phenomenon occurs because the blood leaking from the ruptured spleen irritates the diaphragm, the muscle separating the chest from the abdomen. The irritation is transmitted by the phrenic nerve, which shares nerve roots with the sensory nerves of the shoulder, causing the brain to incorrectly interpret the pain as coming from the shoulder blade.
Beyond the localized discomfort, a person may also experience systemic symptoms that signal internal blood loss. These signs include feeling dizzy, lightheaded, or weak due to a sudden drop in blood volume. The body attempts to compensate for this loss, which can result in a rapid heart rate and pale, cool skin as blood flow is redirected away from the extremities.
Why a Ruptured Spleen is a Medical Emergency
The spleen is an extremely vascular organ. A rupture causes immediate and rapid internal bleeding, or hemorrhage, into the abdominal cavity. This internal blood loss is not visible externally, making it a dangerous and time-sensitive injury.
Uncontrolled bleeding quickly reduces the blood volume. This drop in volume can progress rapidly to a life-threatening condition called hypovolemic shock. During shock, the body’s organs begin to fail because they are not receiving enough oxygenated blood.
Signs of this progression include a drop in blood pressure (hypotension) and a rapid increase in heart rate (tachycardia) as the heart strains to pump the remaining blood. Mental status changes, such as confusion, restlessness, or anxiety, also occur as the brain becomes deprived of oxygen. Rapid stabilization and intervention are imperative to prevent organ failure and death.
Urgent Diagnosis and Treatment
Once a ruptured spleen is suspected, especially following a traumatic injury, the medical team initiates a rapid sequence of diagnostic tests. For patients who are hemodynamically unstable (with low blood pressure and a rapid heart rate), an immediate Focused Assessment with Sonography for Trauma (FAST) ultrasound is performed. This quick, bedside test allows emergency personnel to detect free fluid, which is likely blood, pooling in the abdomen.
If the patient’s condition is stable, a more detailed imaging study, typically a computed tomography (CT) scan with intravenous contrast dye, is utilized. The CT scan provides a clearer image of the spleen, allowing physicians to precisely locate the tear and grade the severity of the injury, usually on a scale of I to V. The grade of the injury is a significant factor in determining the course of treatment.
Treatment options depend on the severity of the rupture and the patient’s stability. For lower-grade injuries, non-surgical management is often the first choice, involving close observation in the hospital to monitor vital signs and check for ongoing bleeding. Blood transfusions may be given to replace lost volume while the spleen attempts to heal itself.
Higher-grade injuries or those where the patient remains unstable despite initial efforts require surgical intervention to stop the hemorrhage. Surgeons will attempt to repair the spleen, a procedure called splenorrhaphy, or remove only the damaged portion in a partial splenectomy. If the injury is severe and the bleeding cannot be controlled, the entire organ must be removed in a procedure known as a splenectomy.