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Ruptured spleen

 
, medical expert
Last reviewed: 07.07.2025
 
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A ruptured spleen usually results from blunt abdominal trauma.

Enlargement of the spleen due to fulminant infection with the Epstein-Barr virus (infectious mononucleosis or posttransplant pseudolymphoma) predisposes to rupture from minimal trauma or even spontaneous rupture. A significant blow (eg, a car accident) can rupture even a normal spleen.

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Symptoms of a ruptured spleen

Rupture of the splenic capsule results in significant bleeding into the abdominal cavity. Common clinical manifestations include hemorrhagic shock, abdominal pain, and distension. Trauma to the spleen can result in a subcapsular hematoma, which may not rupture for hours or even months after the injury.

Rupture is usually preceded by upper left quadrant pain. Splenic rupture should be suspected in patients with blunt abdominal trauma and hemorrhagic shock or upper left quadrant pain (which sometimes radiates to the shoulder); patients with unexplained upper left quadrant pain, particularly if there is evidence of hypovolemic shock, should be asked about previous trauma. Diagnosis is confirmed by CT scanning (in stable patients), ultrasound, or peritoneal lavage (in unstable patients).

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Treatment of ruptured spleen

Treatment of splenic rupture traditionally consists of splenectomy. However, splenectomy should be avoided whenever possible, particularly in children because of the persistent increased susceptibility to bacterial infections later in life. In these cases, transfusion therapy is necessary.

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