Diagnostics

If a rupture of the spleen is suspected, an ultrasound (sonography) of the abdomen is immediately performed at the clinic. The ultrasound can quickly and safely rule out even minor bleeding of the spleen and larger capsule bleedings. In patients with little suspicion of a ruptured spleen and in good general condition, computer tomography can also be performed. The advantage here is that computer tomography can also very well depict minor injuries of the spleen and capsule, which is sometimes difficult with ultrasound. Examination of the blood in the laboratory can give an indication of anemia, but is not a diagnostic substitute for a ruptured spleen.

Therapy

The therapy depends on the severity of the splenic laceration. Over a long period of time, the organ had to be completely surgically removed (splenectomy) even in the case of a less pronounced splenic laceration. However, due to the risks and consequences that this surgical procedure entails for the patients concerned, preference is now being given to surgery that preserves the organ.

In the case of ruptured capsules (splenic rupture grade 1) and small bleedings, it is often sufficient to control and wait for the spleen and the bleeding by ultrasound, i.e. to perform a conservative treatment. For the affected patients, the main focus is on pain relief and the prevention of infections. In addition, care must be taken to ensure that any possible loss of blood and/or fluid is promptly compensated by infusions.

During the entire therapy, however, close-meshed ultrasound checks must be carried out. In addition, the circulation parameters (especially pulse and blood pressure) and the blood count of the affected patient should be checked regularly. Especially the common inflammation parameters (leukocytes, C-reactive protein and blood sedimentation rate) and the number of individual blood cells play a decisive role in this context.

Complications can rarely be observed with a 1st degree splenic rupture and adequate therapy. The bleeding is often stopped by the body’s own blood clotting. A splenic rupture of the 2nd or 3rd degree (in these cases there is no injury to the vascular style) should, if possible, be operated on with spleen preservation.

Surgical therapy of the ruptured spleen is carried out in affected patients by means of infrared or electrocoagulation. In this procedure, infrared rays or alternating current with a particularly high frequency are used to close the affected tissue and stop bleeding. The use of a special fibrin glue can also help to stop the bleeding that occurs in the case of a ruptured spleen.

In the case of a splenic rupture of the 4th degree (in which an injury or rupture of the vascular style occurs), it is often possible to preserve at least a small functional part of the organ. However, a splenic rupture of the 5th degree (in which the blood supply to the spleen is completely interrupted) must usually be treated by a complete removal of the spleen (splenectomy).In addition, the age of the affected patient also plays a role in the choice of the most suitable therapy method. While children and adolescents are treated with all possible means to preserve their organs, older patients are mainly considered for a splenectomy.

The reason for this is the fact that the complication rate during and after surgery is significantly lower in adults. In addition, unfavorable anatomical conditions may mean that complete removal must be preferred to organ preservation. This is especially the case with very overweight patients (obesity).

The prognosis for a ruptured spleen depends primarily on the blood loss, the concomitant injuries, the patient’s age and the therapy chosen. If an appropriate therapy is initiated promptly, the prognosis for a mildly pronounced splenic rupture is very good. One of the most common complications of splenectomy is the so-called OPSI, a disease that can occur with a bacterial infection after removal of the spleen.

In order to avoid this complication, children are vaccinated before the planned removal of the spleen or patients are treated with antibiotics. In the case of a rupture of the spleen (splenic rupture), it is first of all important to stop the bleeding into the abdominal cavity and since the spleen is an organ with a very good blood supply, quick and targeted action is necessary. Depending on where the spleen is ruptured, different surgical procedures are used.

In case of a rupture of the spleen (splenic rupture) at the edges of the spleen (spleen periphery), one always tries to preserve the remaining tissue. Particularly in children, the preservation of the spleen is important, as it takes over important tasks of the immune system. If the spleen is now ruptured at the edges, an attempt is made to overstitch the spleen.

A further procedure is fibrin gluing, where fibrin, which is also a substance produced naturally in the body and plays an important role in wound healing, acts as a kind of tissue adhesive. In addition, bleeding from the torn area can be stopped by pinching off the artery that supplies this area (ligature of a segmental artery). Bleeding can also be stopped by compressing the spleen with a so-called Vicryl mesh.

If the removal of a spleen segment (partial splenectomy) is necessary, this can be done with a laser. If the rupture of the spleen (splenic rupture) is at the point where the vessels enter and exit the spleen (splenic hilum) or if the spleen is too severely damaged by the rupture, a complete removal of the spleen is usually necessary (splenectomy). Since this operation is very often an emergency operation, the abdomen is opened centrally (median laparotomy) and the spleen is detached from the diaphragm.

It is also important here that the vessels supplying the spleen are clamped. Once the spleen has been removed or, in the case of smaller splenic lacerations as described above, the source of bleeding into the abdominal cavity is also eliminated. Complications may also occur during the operation, such as increased blood loss, which must be compensated by administering blood preservatives (blood transfusion).

As with any surgery, there is a risk of wound healing disruption and post-operative bleeding. Particularly with the complete removal of the spleen, there is an increased risk of blood poisoning (sepsis). For this reason, children under the age of 6 should always try to preserve part of the spleen.

To reduce the risk of blood poisoning, vaccination is usually carried out after a splenectomy, especially against the so-called pneumococci. Pneumococci are bacteria. As after other operations, preventive therapy to avoid the formation of blood clots (thrombosis prophylaxis) is started after a splenectomy.