Spleen ruptured. Symptoms in adults, consequences, severity of harm to health, diagnosis

The spleen is a parenchymal internal organ, which is located in the upper part of the abdominal cavity on the left. Covered with a thin epithelial capsule that prevents damage during active physical activity. The spleen is not one of the vital organs of the human body.

Despite this, the appearance of a rupture of its tissues entails the development of acute symptoms, which is accompanied by profuse internal bleeding, severe pain, and disruption of the whole body. This pathology is considered the most common in adults who lead an active lifestyle.

Patients with signs of rupture of the spleen need an emergency examination with further surgical treatment.

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A ruptured spleen is a pathological condition of this organ, which is classified according to the severity of the injury received, as well as the presence of corresponding symptoms in adults and children.

The table below shows the main types of damage of this type:

Types of ruptured spleen	Characteristics of the pathological state of the organ
Contusion	Contusion is the mildest degree of damage to the spleen. In this case, a rupture of a small area of ​​the parenchyma occurs, but at the same time the integrity of the main capsule of this organ is preserved. A patient with similar symptoms requires surgery with a minimal risk of complications associated with the implementation of surgery. After restoring the integrity of the spleen parenchyma, the patient is able to lead the old way of life. In the presence of a concussion, there is no need to carry out a complete removal of the organ.
Capsule rupture	The rupture of the spleen capsule most often occurs with injuries of the abdominal cavity, which have arisen due to the contact of the surface of the left hypochondrium with sharp objects. In this case, there is a violation of the integrity of the protective shell of the organ, but its parenchymal tissue remains intact. Rupture of the spleen capsule is a moderate injury.
One-time break	Obtaining a one-stage rupture of the spleen provides for a simultaneous violation of the integrity of the protective capsule of the organ and its parenchyma. This type of injury is dangerous to the victim's health and requires urgent surgical procedures to stop internal bleeding. A one-time rupture of an organ is quite common in people with multiple body injuries who have experienced a fall from a great height.
Two-moment rupture	Two-stage rupture of the spleen is characterized by staged damage to this organ. Initially, against the background of the injury received, a rupture of the parenchymal tissues occurs, and after a certain period of time, a subsequent violation of the integrity of the organ capsule occurs. The main danger of this type of injury is that secondary rupture progression can occur at any time.
Imaginary Type Two-Moment Discontinuity	This type of damage to the spleen is also called the simultaneous rupture of the parenchymal tissue and the protective capsule with further tamponade of the damaged area. In this case, the part of the organ with impaired integrity is blocked by a dense blood clot even before the onset of symptoms characteristic of severe damage to the spleen. After a certain period of time, the formed blood clot is washed out, which entails the opening of extensive internal bleeding. The task of doctors who diagnose a patient with signs of a two-stage rupture of the spleen imaginary type, timely detect not only the presence of damage, but also the fact of organ tamponade by thrombosis.
Imaginary Type Three-Moment Discontinuity	This type of violation of the integrity of the spleen is characterized by the presence of a two-stage rupture of the parenchyma and the protective capsule, which after a certain period of time begins to close with blood clots. In this case, the opening of internal bleeding occurs much later than usual. A three-stage rupture of the spleen is characterized by profuse blood loss, which begins suddenly, and also threatens the patient's life.

In medical practice, the overwhelming majority of injuries to the spleen tissues are simultaneous ruptures, the receipt of which is accompanied by the immediate opening of internal bleeding into the abdominal cavity.

This type of damage to this organ does not present any particular difficulties in diagnosis, it allows you to timely detect pathology and take measures to stop blood loss. Two-stage organ ruptures occur in 13% of all patients with similar injuries.

The average duration of the time interval from the moment of damage to the spleen to the opening of internal bleeding can range from several hours to 2 weeks.

It all depends on the nature of the injury, the reasons that provoked it, as well as the individual characteristics of the patient's body.

Stages and degrees

A ruptured spleen (symptoms in adults are accompanied by acute pain) is an organ injury that is classified into 4 main degrees of severity.

Single organ damage

In this case, the patient has a violation of the transcapsule integrity of the spleen with the formation local and minor damage, the total size of which does not exceed values ​​from 0.5 to 8.0 cm. According to medical statistics, about 44% of patients are admitted to the hospital of the surgical department with this severity of spleen injuries.

In this case, it is possible to preserve the functions of the organ without the need to remove it. The decision on the appropriateness of the surgical intervention is made by the attending surgeon.

Multiple damage

This severity of the violation of the integrity of the spleen is characterized by the receipt of multiple transcapsule damage to the organ. Patients with similar symptoms require emergency hospitalization, which provides for further surgery to prevent intra-abdominal hemorrhage.

This severity of damage to the spleen occurs in 11.7% of patients with a similar diagnosis.

Detachment of the capsule protective shell

Extensive detachment of the spleen capsule is a pathological condition of the organ, which is characterized by the presence of acute symptoms and profuse blood loss. An injury of this severity is characterized by the presence of multiple two-component ruptures with the risk of developing a large number of complications.

In almost all cases, the presence of such damage requires the removal of the spleen tissue.

Crushing

Crushing of the organ capsule with fragmentation of its parenchymal tissues is a severe trauma. Such symptomatology is typical for patients who survived car or railway accidents, fell from a great height, and have concomitant polytrauma of the abdominal cavity.

This degree of severity of damage to the spleen provides for the immediate removal of the remnants of its tissues with the cessation of internal bleeding. The prognosis for the patient's complete recovery is favorable only if timely surgical assistance is received. Otherwise, the risk of developing irreversible complications inside the abdominal cavity increases.

Symptoms and Signs

A ruptured spleen (symptoms in adults depend on the severity of the injury) is a pathology, the signs of which are acutely manifested, or are accompanied by minor internal bleeding. The clinical picture of damage to this organ can be quite blurred, which requires a high-quality diagnosis of the abdominal cavity.

The following are the most common symptoms of tissue rupture and spleen capsule rupture:

• sharp or aching pain that is localized in the left hypochondrium, or in the upper abdomen (most patients complain that the pain syndrome spreads from the abdominal cavity to the base of the left scapula and radiates to shoulder);
• a pronounced feeling of discomfort inside the abdomen forces the patient to take a forced horizontal position on the left side with tucked legs, which slightly facilitates his well-being;
• in the process of palpation of the abdomen, it is found that the anterior wall of the abdominal cavity does not take part in performing the act of breathing (during breathing, the body of an injured person uses exclusively muscles chest);
• a few hours after the injury to the spleen, severe intestinal paresis develops, which is expressed by a delay in gas, a complete absence of defecation, and severe bloating;
• internal bleeding opens, which can only be stopped with the help of surgical intervention;
• blood pressure indicators are rapidly falling, which is due to profuse blood loss;
• the pulse becomes more frequent, which can also be accompanied by a violation of the rhythmic activity of the heart;
• dizziness appears, coordination of movements is impaired, which ultimately leads to the onset of a fainting state;
• an external examination of the patient reveals an increased pallor of the skin and the presence of sticky sweat, which is due to internal bleeding;
• excessive psychoemotional excitement of the nervous system is replaced by a rapid extinction of activity with further loss of consciousness;
• the patient complains of a constant feeling of nausea, incessant vomiting opens.

Patients with signs of rupture of the spleen are characterized by rapid fatigue, physical weakness, and shortness of breath. In most cases, there are complaints of severe tinnitus, which is explained by unstable blood pressure due to increasing blood loss.

The presence of the above symptoms indicates that the patient is in a serious condition, and also needs urgent help from a surgeon.

Causes

A ruptured spleen (symptoms in adults are accompanied by severe pain in the left hypochondrium) occurs under the influence of physiological and pathological factors. In the first case, anomalies of the physical development of the parenchyma or capsular membrane, the individual characteristics of the patient's body can act as the cause of the violation of the integrity of this organ.

The presence of pathological factors involves the formation of a rupture of the spleen under the influence of disease and physical injury. There are the following reasons for violations of the integrity of the parenchymal tissue and the capsular membrane of the spleen, which are most often found in surgical practice.

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• falls from a great height;
• the consequences of a car or railway accident;
• industrial injuries during work with increased danger;
• too low mobility of organ tissues, the integrity of which was violated at the time of heavy physical exertion, sharp jerks by the body;
• excessive plethora of parenchymal tissues of the spleen;
• insufficiently strong or too thin capsule shell of the organ, unable to withstand active physical activity;
• an increased degree of friability of the parenchyma (in this case, the risk of profuse blood loss increases sharply);
• blows to the left side of the abdominal cavity;
  
• a pathological process in the tissues of the spleen, accompanied by splenomegaly (the nature of the origin of the diseased state of the organ does not matter).

In a person who has suffered an injury to the spleen without signs of disrupting the integrity of its tissues, but at the same time already has formed subcapsular hematoma, rupture of the parenchyma of this organ occurs under the influence of the following factors.

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• sneezing;
• coughing;
• run;
• lifting heavy objects;
• the act of defecation;
• fast walk;
• rolling from side to side in bed.

In this case, the damage to the spleen is minor with the appearance of small ruptures. A few hours after the violation of the integrity of the tissues of the organ, the person begins to feel a rapid deterioration in health with increasing pain in the left hypochondrium.

Diagnostics

A ruptured spleen (symptoms in adults are determined by external examination of the patient and by the method of instrumental diagnostics) should be established in the first hours after the injury.

Otherwise, the progression of profuse blood loss develops with the appearance of concomitant signs of pathology. To establish the fact of damage to the tissues and the capsular membrane of the spleen, it is necessary to use hardware diagnostic methods.

X-ray of the abdomen and chest

This diagnostic method is used to identify pathological opacities that indicate the presence of internal bleeding. If the fact of rupture of the spleen is confirmed, a homogeneous shadow will be found on the X-ray under the diaphragm on the left.

Additional symptoms of pathology, which can be determined using X-ray examination, are low mobility and too high position of the dome of the diaphragm on the left side, expansion of the stomach, as well as displacement of the colon intestines.

The main disadvantage of this type of diagnosis is that with scant symptoms, the presence of a central hematoma of the spleen, the results of radiography can leave a large number of questions. The average cost of an X-ray examination is 850 rubles.

Laparoscopy

Laparoscopy belongs to the category of endoscopic diagnostic methods, which has the maximum information content. In this case, a surgeon performing an examination of a patient with signs of a ruptured spleen, gets the opportunity not only to establish the presence of internal bleeding, but to find the source pathology.

The principle behind this survey is as follows:

1. The patient is transferred to a sterile room for endoscopic diagnostics.
2. After using anesthetics, the doctor punctures the anterior wall of the abdominal cavity, into which an endoscopic device is inserted.
3. The device, equipped with a digital video camera, records the state of the internal organs of the peritoneum, detects the presence or absence of bleeding, and also displays the state of the spleen tissues.

All collected information is transmitted in real time to a computer monitor. Based on the results of this diagnosis, the surgeon decides on the method of further treatment. The average cost of this survey method is 15,970 rubles.

Laparocentesis

Laparocentesis is a surgical diagnostic technique that is used in the absence of endoscopic equipment. For example, if a patient is delivered to a district clinic, which is not equipped with all the necessary material and technical base.

A distinctive feature of this examination method is that with the help of surgical instruments the doctor pierces the anterior abdominal wall. A catheter is inserted into the resulting hole. In the presence of a ruptured spleen with the opening of internal bleeding, blood will begin to flow from the open abdominal cavity.

The main disadvantage of this diagnostic method is the ability to establish the most dangerous symptom of damage parenchymal organ in the form of internal bleeding, but at the same moment the doctor cannot determine the source pathology. The average cost of laparocentesis is 5,000 rubles.

Treatment and rehabilitation methods

Surgery is the main treatment for a ruptured spleen. In this case, the therapeutic process involves the complete removal of the damaged organ, or the suturing of its tissues while preserving its physiological functions.

In the first case, excision of the spleen is indicated in the presence of severe injuries with signs of crushing and detachment of its individual fragments. The decision to suture organ tissues is made by a surgeon if the parenchymal injuries are single, shallow and allow for organ-preserving surgery.

In parallel with the performance of the surgical intervention, urgent resuscitation measures are carried out aimed at restoring stable hemodynamics.

The attending physician assesses the severity of the consequences caused by internal bleeding.

The patient is prescribed a blood transfusion and blood substitutes are administered. This surgical operation is performed under general anesthesia, and its average duration ranges from 1.5-2 h depending on the severity of the clinical case, as well as the presence of concomitant injuries of the abdominal organs.

In a public hospital, this type of surgery belongs to the category of emergency and urgent care, for which no fee is charged. In a private clinic, the average cost of removing the spleen will be from $ 10 to $ 15 thousand. rub.

Rehabilitation after complete removal of the spleen involves the following:

• wearing a special bandage that supports the muscles of the anterior abdominal cavity;
  
• adherence to postoperative dietary nutrition;
• the implementation of a slow walk in the first days after surgery to prevent the development of the adhesive process;
• exclusion of physical activity.

In the first 3-5 days after surgery, it may be necessary to take antibacterial and analgesic drugs, the type and dosage of which is determined by the attending surgeon. The average duration of postoperative recovery of the body is 3 weeks.

Possible consequences and complications

In the absence of a timely surgical operation to remove or suture the damaged organ, the patient is expected to die from internal blood loss. A ruptured spleen is a pathological condition of this organ, the main symptoms of which are the presence of severe pain in the left hypochondrium, dizziness, pallor of the skin.

Damage of this type is most often diagnosed in adults who lead an active lifestyle. A ruptured spleen can provoke blows to the left side of the abdomen, falls from great heights, sharp turns and jerks to fast movement.

It is extremely important that a violation of the integrity of this organ is detected in the first hours after injury. Otherwise, it is possible to open profuse internal bleeding with a risk of death.

Spleen ruptured video

Post-traumatic rupture of the spleen: