Splenic rupture – colloquially called splenic laceration – (ICD-10-GM S36.0-: Injury to the spleen) refers to a tear of the connective tissue capsule of the spleen (with or without parenchymal injury), which may be traumatic or nontraumatic in origin.
The most common cause of splenic rupture is abdominal trauma (force to the abdomen; traumatic splenic rupture), usually as blunt abdominal trauma, i.e., the abdominal wall is intact. Work, traffic, or sports accidents may be the cause. Perforating abdominal trauma, for example, stabbing, gunshot, or impalement injuries, can also result in splenic rupture but are rare.
In a few cases, splenic rupture may result from nontraumatic causes (ICD-10-GM D 73.5-: Infarction of the spleen: splenic rupture, nontraumatic), i.e., spontaneous. Causes of spontaneous rupture of the spleen without trauma include specific infectious diseases (e.g., infectious mononucleosis (Epstein-Barr virus infection), malaria) or hematologic diseases (e.g., leukemias/blood cancers) associated with splenomegaly (abnormal splenic enlargement).
Because splenic rupture can lead to massive intra-abdominal hemorrhage (“located within the abdomen”), any patient with suspected splenic rupture should be admitted immediately as an emergency inpatient.
Splenic rupture is differentiated according to acute clinical symptoms as follows:
- Single-stage splenic rupture: simultaneous rupture of capsule and parenchyma → immediately after the traumatic event, development of hemorrhagic-induced hypovolemia (decrease in the amount of blood in the circulation due to hemorrhage).
- Two-stage splenic rupture: occurrence of a symptom-free interval of several hours, to days, to weeks, until it comes to the development of hypovolemia; initially, only a rupture of the parenchyma with bleeding into the still intact capsule is present here → development of an increasing central or subcapsular hematoma (bruise under the capsule) → increasing pressure increase, which after a symptom-free interval leads to a spontaneous capsular rupture
Classification of splenic rupture (splenic rupture) into 5 types according to severity see below “Classification”.
The lethality (mortality relative to the total number of people suffering from the disease) is up to 15% (strongly fluctuating data) and is strongly dependent on concomitant injuries.
Course and prognosis: The course and prognosis depend on the severity of the splenic rupture and its underlying cause.Depending on the extent of the splenic rupture, conservative therapy is performed under close inpatient control. In most cases, surgical therapy is necessary. If possible, surgery is performed to preserve the spleen. In case of extensive injuries (organ fragmentation; rupture at the hilus) a splenectomy (surgical removal of the spleen) is usually necessary.
In childhood, preservation of the spleen is successful in isolated splenic trauma under conservative procedures in more than 75% of cases; in adults in up to about 65% of cases.
After splenectomy, there is a risk of postsplenectomy syndrome (OPSI syndrome; overwhelming postsplenectomy infection syndrome; foudroyant sepsis) in 1-5% of cases.
Note: In case of splenectomy, pneumococcal vaccination must be given immediately postoperatively. This is an indication vaccination for risk groups. Duration of vaccination protection varies greatly from individual to individual, approximately 3-5 years!
