Introduction
Rupture of the spleen, also called splenic rupture, is the injury to the spleen. This is most frequently caused by blunt abdominal trauma (for example in car accidents), less frequently by a spontaneous rupture due to illness. The spleen serves to secrete red blood cells, store and multiply white blood cells and is therefore an organ with a very good blood supply. Therefore, the therapy of choice is often surgery, as otherwise the patient may bleed to death. In rare exceptions, a ruptured spleen can also be treated conservatively.
Causes
A distinction is made between the causes of traumatic and non-traumatic events. The spleen is actually well protected on the left side under the last ribs, under the diaphragm and above the left kidney. Therefore, it usually requires more severe accidents to injure the spleen.
This is usually caused by car, motorcycle or bicycle accidents in which the handlebars of the bicycle are pressed into the abdomen. Rarely, broken ribs, which can puncture the spleen, or injuries caused by an operation in the abdominal cavity can also be the cause. Equally rare are non-traumatic causes such as rupture of the spleen due to diseases such as Pfeiffer’s glandular fever (mononucleosis) or cancer.
Normally, however, a rupture of the spleen in diseases is only possible and therefore predictable when the organ is very much enlarged. A rupture of the spleen (splenic rupture) can generally occur as a result of severe trauma, such as accidents with a bicycle or car. In the case of a previously damaged spleen, a rupture can also occur spontaneously.
Sneezing generates higher pressure in the abdominal cavity (intra-abdominal), which can in principle have a damaging effect on the organs located there. For this increase in pressure to have such a damaging effect on the spleen that a rupture of the spleen due to sneezing can occur, the spleen must generally be pre-damaged. This pre-damage can be caused by a virus such as the whistling fish glandular fever (Eppstein-Barr virus, EBV).
This disease is characterized, among other things, by an enlarged spleen (splenomegaly). In this enlargement of the spleen, the spleen capsule in particular is very tense and strained. In this case, a spontaneous rupture of the spleen and its capsule can also occur.
Of course, the spleen ruptures even more easily in this tense state if there is an increase in pressure, for example, due to a strong sneeze. Another reason for a swelling of the spleen and thus an increased risk of splenic rupture can be a blood clot in the large liver vein (portal vein thrombosis). This clot causes the blood to back up into the spleen, which then swells.
Here too, the sudden increase in pressure in the abdominal cavity caused by sneezing can lead to a rupture of the spleen. This form of splenic rupture caused by sneezing is rather rare and is immediately noticed by severe pain. This pain is often located in the upper abdomen and is intensified by pressure.
In general, a rupture of the spleen caused only by sneezing is very rare and even in the case of a previously damaged spleen, a little more pressure is usually necessary to cause it to rupture. Of course, the increased probability of a rupture of the spleen caused by sneezing is also determined by the degree of previous damage. The more the spleen is swollen and the more tightly the capsule is stretched, the easier it is for the spleen to rupture due to natural sudden increases in pressure such as sneezing.
Smaller ruptures of the capsule and smaller injuries to spleen tissue are more common than a complete rupture of the vessels supplying the spleen. If, after a severe sneezing with a known severely damaged spleen, new severe pain occurs, a doctor should be consulted so that an ultrasound (sonography) can be used to rule out a rupture of the spleen. In general, a rupture of the spleen due to sneezing is a very rare complication.
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