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; initially, here, there is only a rupture of the parenchyma with bleeding into the still intact capsule → development of an increasing central or subcapsular hematoma (hematoma under the capsule) → increasing increase in pressure, leading to spontaneous capsular rupture after a symptom-free interval
Etiology (causes)
Disease-related causes
- Abdominal trauma (abdominal trauma)
- Blunt abdominal trauma, i.e., the abdominal wall is intact: e.g., work, traffic, or sports accidents
- Perforating abdominal trauma: e.g., stabbing, gunshot or impalement injuries.
- Infections, special (infectious mononucleosis (Epstein-Barr virus infection); malaria.
- Hematological diseases (blood diseases) associated with splenomegaly (abnormal splenomegaly) (e.g., leukemias/blood cancers).
- Splenic tumors (e.g., malignant lymphomas (various cancers of the lymphatic system) and angiomas (malformation of the vessels))
- Portal vein thrombosis – vascular disease in which a blood clot (thrombus) has formed in the portal vein of the liver
- Polytrauma – multiple injuries sustained simultaneously in different regions of the body, where at least one injury or the combination of several injuries is life-threatening (definition: Harald Tscherne).
- Rib fractures (rib fractures), lower left, which can lead to splenic rupture due to impingement on the spleen
Other causes
- Iatrogenic (caused by the physician), e.g., during surgery (e.g., superficial capsular tears due to traction on the stomach, on the left flexure of the colon, or due to crushing caused by the use of abdominal hooks)
