Spleen Injury
Trauma to the spleen, a common cause of internal bleeding
Quick Facts
- Type: Abdominal organ injury
- Common causes: Car crashes, sports, falls, assault
- Main danger: Internal bleeding
- Seek urgent care: Left upper belly pain, dizziness, fainting after trauma
Overview
The spleen is a fist-sized organ in the upper left part of the abdomen, tucked under the rib cage. It filters blood and helps fight infection. Because it is soft and full of blood vessels, the spleen is one of the most commonly injured organs in abdominal trauma, and a tear can lead to rapid internal bleeding.
Spleen injuries range from a small bruise or shallow tear to a complete rupture that bleeds heavily. A ruptured spleen is a medical emergency. With prompt diagnosis, many spleen injuries can be managed without surgery, but severe injuries may require an operation to stop the bleeding. Doctors grade these injuries by severity, from minor surface tears to deep ruptures involving the central blood vessels, and this grading helps guide whether close monitoring or surgery is the safest approach. Modern care increasingly tries to preserve the spleen when possible, because it plays an important role in the immune system.
Symptoms
Symptoms depend on the amount of bleeding. After a significant blow to the abdomen or left lower chest, watch for:
- Pain in the upper left abdomen
- Tenderness when the belly is touched
- Pain in the left shoulder, especially when lying down (a sign of irritation from internal blood, called Kehr's sign)
- Lightheadedness, dizziness, or confusion
- Pale skin, rapid heartbeat, and low blood pressure
- Fainting
Bleeding from a spleen injury can be sudden or develop gradually over hours to days. Any of these warning signs after trauma is an emergency.
Causes
Most spleen injuries result from blunt force to the abdomen or left lower chest.
- Motor vehicle collisions: The most common cause, particularly from seatbelt and steering wheel impacts.
- Sports injuries: Blows during contact sports such as football, rugby, or martial arts.
- Falls: Especially from a height or onto the left side.
- Assault: A punch, kick, or blow to the abdomen.
- Penetrating wounds: Stab or gunshot wounds.
An enlarged spleen, which can occur with infections such as mononucleosis, is more fragile and can rupture from minor trauma.
Risk Factors
- High-impact or contact sports
- Driving without a seatbelt or at high speed
- An enlarged spleen from infection (such as mononucleosis) or other illness
- Bleeding disorders or use of blood-thinning medication
- Activities with a high risk of falls
Diagnosis
Because spleen bleeding can be hidden, doctors evaluate suspected injuries quickly:
- Physical examination: Checking the abdomen for tenderness and rigidity, along with vital signs.
- FAST ultrasound: A fast bedside scan to look for free blood in the abdomen.
- CT scan: The most detailed test for a stable patient, showing the grade of injury and any active bleeding.
- Blood tests: To monitor blood counts and clotting.
Treatment
Treatment depends on the severity of the injury and whether the patient is stable.
- Non-operative management: Many spleen injuries in stable patients are watched closely in the hospital with rest, fluids, and repeat scans. Preserving the spleen helps maintain its role in fighting infection.
- Angioembolization: Blocking a bleeding vessel from inside using a catheter can stop bleeding without surgery.
- Surgery: For uncontrolled bleeding, surgeons may repair the spleen or remove it (splenectomy).
People who have their spleen removed are more vulnerable to certain infections and are usually advised to receive specific vaccinations and, sometimes, preventive antibiotics.
Prevention
- Wear a seatbelt and drive at safe speeds
- Use protective equipment in contact sports
- Avoid contact sports while you have an enlarged spleen, such as during recovery from mononucleosis
- Reduce fall hazards at home and work
- Discuss bleeding risk with your doctor if you take blood thinners
When to See a Doctor
Any significant blow to the left side of the abdomen or lower chest should be checked, even if you feel well at first. Call emergency services or go to the nearest emergency department right away if you have:
- Severe or worsening pain in the upper left abdomen
- Pain in the left shoulder
- Dizziness, confusion, or fainting
- A rapid heartbeat or pale, clammy skin
- A tender, swollen, or rigid belly
Frequently Asked Questions
What is Kehr's sign in a spleen injury?
Kehr's sign is pain felt in the left shoulder caused by irritation from blood pooling near the diaphragm after a spleen injury. It often worsens when lying flat. Shoulder pain after abdominal trauma is a warning sign that needs urgent evaluation.
Can a spleen injury be treated without surgery?
Yes. Many spleen injuries in stable patients are managed without surgery using close hospital monitoring, rest, and repeat scans. Preserving the spleen is preferred because it helps fight infection, but severe bleeding may still require surgery.
What happens if the spleen has to be removed?
People can live without a spleen, but they become more vulnerable to certain serious infections. Doctors usually recommend specific vaccinations and may advise preventive antibiotics, plus prompt treatment of any fever or illness.
How long after mononucleosis is the spleen at risk of rupture?
An enlarged spleen during mononucleosis can rupture with minor trauma. Doctors generally advise avoiding contact sports and heavy activity for at least three to four weeks, and longer if the spleen is still enlarged on follow-up.
References
- American College of Surgeons. Trauma management resources.
- MedlinePlus, U.S. National Library of Medicine. Ruptured spleen.
- Mayo Clinic. Ruptured spleen — Symptoms and causes.
- Centers for Disease Control and Prevention (CDC). Asplenia and vaccination.