Rupture of the Spleen

Splenic Rupture: Test and Diagnosis

Laboratory parameters of the 1st order – obligatory laboratory tests. Small blood count [Hb ↓; leukocytes (white blood cells) ↑] Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, urobilinogen, bilirubin, blood), sediment, urine culture if necessary (pathogen detection and resistogram, i.e. testing of suitable antibiotics for sensitivity/resistance). Electrolytes – calcium, chloride, potassium, … Splenic Rupture: Test and Diagnosis

Splenic Rupture: Diagnostic Tests

Obligatory medical device diagnostics. Abdominal ultrasonography (ultrasonography of abdominal organs). Free intraabdominal fluid? if yes: indication of internal bleeding Predilection sites (body regions where the disease occurs preferentially): Douglas space (in women): pocket-shaped bulge of the peritoneum (abdominal membrane) between the rectum (rectum) at the back and the uterus (uterus) at the front Proust space … Splenic Rupture: Diagnostic Tests

Splenic Rupture: Surgical Therapy

Depending on the overall clinical situation, conservative therapy of splenic rupture up to and including severity type 3 (see “Classification” below) is attempted in hemodynamically stable patients to avoid postsplenectomy syndrome (OPSI syndrome). If surgery is required, it should be spleen-preserving. The following procedures are used for splenic preservation in peripheral ruptures: Oversewing Laser or … Splenic Rupture: Surgical Therapy

Splenic Rupture: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate a ruptured spleen (splenic rupture): Unilateral splenic rupture Abdominal pain in the left upper quadrant (left upper abdomen). Possibly local defensive tension (acute abdomen). Possibly radiation of pain into the left shoulder (= Kehr sign). Possibly pressure painfulness of the “spleen point”: left side of the neck (located … Splenic Rupture: Symptoms, Complaints, Signs

Splenic Rupture: Causes

Pathogenesis (development of disease) Single-stage splenic rupture: simultaneous rupture of capsule and parenchyma → development of hemorrhagic-induced hypovolemia (decrease in the amount of blood in the circulation due to hemorrhage) immediately after the traumatic event Two-stage splenic rupture: occurrence of a symptom-free interval of several hours, to days, to weeks, until the development of hypovolemia; … Splenic Rupture: Causes

Splenic Rupture: Complications

The following are the most important diseases or complications that may be contributed to by splenic rupture (splenic rupture): Blood, blood-forming organs – Immune system (D50-D90). Susceptibility to infection (due tocondition after splenectomy (after surgical removal of the spleen)). Thrombocytosis (pathological increase in blood platelets (thrombocytes)), passive/temporary occurrence (after surgical removal of the spleen) Infectious … Splenic Rupture: Complications

Splenic Rupture: Classification

Classification of splenic rupture (splenic laceration) into 5 types according to severity by American Association of the Surgery of Trauma. Severity Capsular tear, parenchymal injury Hematoma (bruise) Type 1 Isolated capsular tears without acute bleeding Parenchymal injury <1 cm Subcapsular hematoma(bruise under the capsule);spread < 10% of the surface, not increasing. Type 2 Capsular rupture … Splenic Rupture: Classification

Splenic Rupture: Examination

The entire body should always be examined to rule out concomitant injuries! A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin (complete undressing to include all wounds) [bruise marks? – e.g., seat belt marks, steering wheel; hematomas?; … Splenic Rupture: Examination

Splenic Rupture: Medical History

Medical history (history of illness) is an important component in the diagnosis of splenic rupture (splenic laceration). Family history Social history Current medical history/systemic history (somatic and psychological complaints). Can you show me (describe) exactly where the pain is localized? Is the pain always in the same place? How long has the pain been present? … Splenic Rupture: Medical History

Splenic Rupture: Or something else? Differential Diagnosis

The following is a listing of all differential diagnoses in the setting of acute abdomen (the most common in bold). Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Duodenal atresia (synonym: duodenojejunal atresia) – congenital developmental disorder in which the lumen of the duodenum is not patent [premature/newborn]. Ileum atresia – congenital developmental disorder in which … Splenic Rupture: Or something else? Differential Diagnosis