Symptoms
The symptoms in the presence of a ruptured spleen are in most cases quite classic, although it is always difficult to detect a ruptured spleen. As a rule, even a brief questioning of the patient regarding the course of the accident provides an initial indication. In general, it can be assumed that any blunt trauma affecting the left upper abdomen and/or the left flank causes damage to the spleen with almost 90 percent probability.
Typical symptoms of a mild splenic rupture (e.g. a pure capsule rupture) with little pronounced bleeding include pain in the left and/or middle upper abdomen. Other symptoms indicating the presence of a ruptured spleen include pressure pain below the stomach (epigastrium) and knocking pain in the area of the left flank. Many of the affected patients also describe left-sided, breath-dependent complaints as one of the typical symptoms of a ruptured spleen.
In addition, pain radiating into the left shoulder (so-called “sweeping sign”) is one of the most common symptoms perceived by people with a ruptured spleen. In addition, a rupture of the spleen often leads to severe irritation of the diaphragm and the phrenic nerve. As a result, some of those affected experience pain in the left side of the neck (so-called “Saegesser’s sign”).
In general, it can be assumed that the severity of the symptoms correlates strongly with the extent of the parenchyma injury. A higher degree of splenic laceration is manifested in the majority of patients by heavy bleeding and clear symptoms of an impending volume deficiency shock. These typical symptoms include:
- Accelerated pulse rate (tachycardia)
- Low blood pressure (hypotension)
- Accelerated breathing (tachypnea)
- Hyperventilation if necessary
- Cold welding
- Fear
- Unrest
In addition, increasing clouding of consciousness is considered one of the most common symptoms in patients who develop a volume deficiency shock caused by a ruptured spleen.
The direct cause of this clouding of consciousness is a reduced supply of oxygen to the brain. Furthermore, the presentation of free fluid between the spleen and the left kidney in the so-called Koller pouch is considered a typical symptom of a ruptured spleen. In addition, large bruises (haematomas) lying underneath the organ capsule can also be visualized with the help of an ultrasound examination.
The symptoms of a ruptured spleen that are not visible from the outside, on the other hand, cannot be visualized either by taking an x-ray of the rib cage or by imaging the abdominal cavity. Other symptoms (or rather accompanying injuries) that may indicate the presence of a ruptured spleen are rib fractures in the area of the lower left rib cage. Visible injection or puncture marks in the left flank or upper left abdomen can also be seen as an indication of a possible splenic rupture.
If it is unclear whether the splenic tissue has been affected, a computer tomography of the abdomen can be performed in otherwise circulatory stable patients. The preparation of a blood count can also reveal typical symptoms of a ruptured spleen. Since almost all the blood in the body’s circulation must pass through the spleen, a pronounced rupture of the spleen can result in severe blood loss.
In laboratory chemistry, this is primarily manifested by a drastic drop in the red blood pigment (hemoglobin; abbreviated to Hb), the number of red blood cells (erythrocytes) and the so-called “hematocrit” (volume fraction of cellular elements in the blood). In addition, functional disorders of other organs are also considered to be common symptoms in the presence of a ruptured spleen. In particular, the liver and kidneys react quite quickly to a severe impairment of spleen function.
Blood gas analysis usually shows a drop in the oxygen saturation of the remaining blood in the affected patients. In addition, shock-induced hyperacidity of the blood (acidosis) becomes visible in most cases. The rapid increase of white blood cells (leukocytes) in the blood count is also one of the typical symptoms of a ruptured spleen.