The spleen, an organ located in the upper left abdomen beneath the rib cage, plays several important roles. It functions as a filter for blood, removing old or damaged blood cells and storing red blood cells and platelets. The spleen is also a component of the immune system, producing white blood cells and antibodies to help fight infection. A splenic rupture occurs when the spleen’s outer capsule or internal tissue tears, leading to internal bleeding. While often associated with direct trauma, a splenic rupture can also happen spontaneously, without external injury, a condition known as non-traumatic or spontaneous splenic rupture.
Infections Leading to Rupture
Various infectious diseases can weaken the spleen, making it prone to rupture. Infectious mononucleosis, commonly caused by the Epstein-Barr virus, is one example that can lead to splenic enlargement. This enlargement stretches the spleen’s capsule and increases its fragility, making it prone to tearing even with minor stress.
Malaria, particularly caused by Plasmodium vivax, is another infection that can cause spontaneous splenic rupture. The parasite causes splenic hyperplasia and vascular congestion, compromising the splenic capsule. Other viral infections, such as cytomegalovirus (CMV) and human immunodeficiency virus (HIV), have also been linked to splenic rupture. In HIV cases, rupture may occur due to splenomegaly or HIV-associated vasculopathy. Bacterial infections, including infective endocarditis, can lead to splenic abscesses that may rupture.
Blood Disorders and Rupture Risk
Certain hematological conditions can increase the risk of spontaneous splenic rupture. Malignancies affecting the blood, such as leukemias and lymphomas, are common causes. These cancers can enlarge the spleen due to the infiltration of abnormal cells, making it fragile and prone to rupture.
Conditions like myelofibrosis, a bone marrow disorder, also contribute to splenic enlargement and fragility. Other non-malignant blood disorders, including thalassemia and hemolytic anemias, place chronic stress on the spleen. The spleen works harder to filter abnormal or damaged red blood cells, leading to enlargement and increased rupture risk. The increased workload and accumulation of cells can stretch the splenic tissue and capsule beyond its capacity, leading to a tear.
Other Underlying Medical Conditions
Beyond infections and blood disorders, other medical conditions can predispose individuals to non-traumatic splenic rupture. Inflammatory and autoimmune diseases, such as systemic lupus erythematosus (SLE) or polyarteritis nodosa, can cause inflammation within the spleen’s blood vessels or tissue, weakening its structure. Local inflammatory processes like pancreatitis have also been associated with splenic rupture.
Primary splenic tumors, such as hemangiomas or angiosarcomas, or metastatic cancers that spread to the spleen, can also lead to rupture. These growths can compromise the spleen’s integrity, making it vulnerable to tearing. Vascular abnormalities, including splenic artery aneurysms, present a direct risk. A splenic artery aneurysm is a bulge in the artery supplying the spleen, and its rupture is a serious medical emergency that can cause internal bleeding. Certain medications, particularly anticoagulants, can also increase spontaneous splenic rupture risk due to increased bleeding.
Symptoms and Medical Intervention
Recognizing the signs of a splenic rupture is a medical emergency. The most common symptom is severe pain in the upper left abdomen, which may also radiate to the left shoulder, a phenomenon known as Kehr’s sign. This referred pain occurs because blood irritating the diaphragm can trigger pain signals that travel along shared nerve pathways to the shoulder.
Other signs of internal bleeding may include lightheadedness, dizziness, rapid heart rate, and signs of shock (confusion, pallor, low blood pressure). Diagnosis typically involves a physical examination. A computed tomography (CT) scan with contrast is often the primary method for confirming a splenic rupture and assessing the extent of injury. In emergency situations, a rapid ultrasound, known as a FAST exam, can quickly detect internal bleeding.
Treatment depends on the severity of the rupture and the patient’s stability. For hemodynamically stable patients, non-operative management with close monitoring and blood transfusions may be an option. However, if bleeding is severe or the patient is unstable, emergency surgery, often a splenectomy (removal of the spleen), is necessary to control bleeding. In some cases, partial spleen removal or splenic repair may be possible. Arterial embolization, a procedure to block the bleeding vessel, can also be considered in certain situations.