Ruptured Spleen: Difference between revisions
No edit summary |
No edit summary |
||
Line 1: | Line 1: | ||
<div class="editorbox"> | <div class="editorbox"> | ||
<p><b>Original Editors </b>- Nick Hansen & Ren Peterson <a href="Pathophysiology of Complex Patient Problems">from Bellarmine University's Pathophysiology of Complex Patient Problems project.</a> | |||
</p><p><b>Top Contributors</b> - <span class="fck_mw_template"><span class="fck_mw_template">{{Special:Contributors/{{FULLPAGENAME}}}}</span></span> | |||
</p> | |||
</div> | </div> | ||
<h2> Definition/Description </h2> | |||
<p>The spleen is an organ of the lymphatic system located on the left side of your stomach (abdomen) under the rib cage and diaphragm in a region that is referred to as the left upper quadrant. In humans the spleen is about the size of a fist and its primary roles are filtering the body’s blood and helps to fight infection. It also serves a role in storing and releasing certain types of immune cells that mediate tissue inflammation <span class="fck_mw_ref">Encyclopædia Britannica. Encyclopædia Britannica Online Academic Edition. Encyclopædia Britannica Inc.,. Spleen. Available from: http://www.britannica.com/EBchecked/topic/560613/spleen</span> | |||
The spleen is an organ of the lymphatic system located on the left side of your stomach (abdomen) under the rib cage and diaphragm in a region that is referred to as the left upper quadrant. In humans the spleen is about the size of a fist and its primary roles are filtering the body’s blood and helps to fight infection. It also serves a role in storing and releasing certain types of immune cells that mediate tissue inflammation < | </p><p><br />Rupturing a spleen describes an emergency situation in which your spleen has developed a break in its surface. This is serious condition that can occur during a direct blow or trauma and without emergency treatment a ruptured spleen can cause life threatening internal bleeding. <span class="fck_mw_ref">Mayo Foundation for Medical Education and Research (MFMER) 1998-2012. Ruptured Spleen. [Internet] 2012 [updated 2010 Nov 19; cited 2012 Mar 30]. Available from: http://www.mayoclinic.com/health/ruptured-spleen/DS00872</span><br /> | ||
</p> | |||
<br>Rupturing a spleen describes an emergency situation in which your spleen has developed a break in its surface. This is serious condition that can occur during a direct blow or trauma and without emergency treatment a ruptured spleen can cause life threatening internal bleeding. < | <h2> Prevalence </h2> | ||
<p>The prevalence of splenic ruptures are poorly documented but one study suggest that traumatic splenic ruptures are more likely to occur in males (2:1 male to female) with ages ranging from 18-34 years.<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Atraumatic Spleen" /> | |||
</p><p>Infectious Mononucleosis – Annually in the United States there are appropriately 345 – 671 cases per 100,000. Typically involving school age children ages 13-19 years. Approximately 0.1% to 0.2% of the 345 – 671 cases in the United States will suffer from splenic ruptures. “Base on this figure, approximately 100 cases of ruptures may occur yearly in the US, only a few of which are reported.” <span class="fck_mw_ref">Foreman B, Mackler L. Can we prevent splenic rupture for patients with infectious mononucleosis? Journal of Family Practice 2005; 54: 547</span><br /><br /> | |||
</p> | |||
The prevalence of splenic ruptures are poorly documented but one study suggest that traumatic splenic ruptures are more likely to occur in males (2:1 male to female) with ages ranging from 18-34 years. | <h2> Characteristics/Clinical Presentation </h2> | ||
<p>Signs and symptoms of a ruptured spleen includes: <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Mayo Clinic" /><br />• Pain (usually severe but not always) in the upper left portion of the stomach (abdomen) or under rib cage<br />• Tenderness when you touch the upper left portion of the stomach (abdomen) <br />• Left shoulder pain-Kehr’s Sign<br /> | |||
Infectious Mononucleosis – Annually in the United States there are appropriately 345 – 671 cases per 100,000. Typically involving school age children ages 13-19 years. Approximately 0.1% to 0.2% of the 345 – 671 cases in the United States will suffer from splenic ruptures. “Base on this figure, approximately 100 cases of ruptures may occur yearly in the US, only a few of which are reported.” < | </p> | ||
<ul><li>Internal bleeding due to a ruptured spleen can cause blood pressure to drop (hypotension). <span class="fck_mw_ref">↑ WebMD. 2005-2012. Ruptured Spleen. [Internet] [reviewed 2009 Aug 19; cited 2012 Mar 30]. Available from: http://www.webmd.com/digestive-disorders/ruptured-spleen</span> | |||
</li><li><u>Internal bleeding</u>: | |||
</li></ul> | |||
Signs and symptoms of a ruptured spleen includes: | <p> - Blurred vision<br /> - Confusion<br /> - Light-headedness<br /> - Fainting<br /> - Signs of shock (cold clammy skin, pale, weak or rapid pulse) | ||
</p><p><u><b>Kehr's sign</b></u> (Hans Kehr (1862–1913), | |||
<u> | </p> | ||
<ul><li>pain in the left shoulder caused by irritation of the undersurface of the diaphragm by blood leaking from a ruptured spleen. The pain impulses are referred along the phrenic nerve supplying the diaphragm C3-C5 nerve distribution. <span class="fck_mw_ref">A Dictionary of Nursing. 2008. Kehr’s Sign. 29 Mar. 2012 Available at: http://www.encyclopedia.com/doc/1O62-Kehrssign.html.</span> | |||
<br>It is strongly advised to seek immediate medical care if an injury is sustained coupled with pain in the left upper stomach (abdomen) region along with any of the above listed signs and symptoms. If severe injuries are untreated a ruptured spleen can be fatal.<br> | </li></ul> | ||
<p> | |||
</p> | |||
<ul><li>• Video of Kehr’s Sign: <br />https://www.youtube.com/watch?v=UkXghZn2WJ8 <span class="fck_mw_ref">https://www.youtube.com/watch?v=UkXghZn2WJ8</span><br /><br /> | |||
Common co-morbidities for traumatic splenic ruptures are hypertension, type II diabetes, and asthma. In a study involving 538 subjects, 25% suffered from one or more of the co-morbilities listed above. < | </li></ul> | ||
<p><u><b>Castell’s Percussion Tes</b></u><b><u>t:</u></b> Clinical Screen for the presence of splenic inflammation. <br />• Patient Supine<br />• Clinician palpates the left costal margin near the anterior axillary line. <br />• Clinician then instructs the patient to breathe normally while they apply percussion at both full inspiration as well as at rest. <br />• Findings: Positive test if dull sound is present upon full inspiration and expiration. (Indicates spleen descending)<br />• Normal it is only dull at full inspriation and should be tympanic at rest. <br />• Important: If spleen is found to be inflamed, DO NOT continue to palpate as it can lead to a rupture. <span class="fck_mw_ref">Examination of the Spleen. Examination of the Spleen | Stanford Medicine 25 | Stanford Medicine. http://stanfordmedicine25.stanford.edu/the25/spleen.html. Accessed April 4, 2017.</span><br /> | |||
Non-traumatic splenic ruptures can be associated with numerous conditions and diseases. Some of the most common include, lymphoma, cirrhosis of the liver, liver disease, pancreatic pathology, bone marrow disorders such as leukaemia, and blood clotting disorders. | </p><p><br />It is strongly advised to seek immediate medical care if an injury is sustained coupled with pain in the left upper stomach (abdomen) region along with any of the above listed signs and symptoms. If severe injuries are untreated a ruptured spleen can be fatal.<br /> | ||
</p> | |||
Viral diseases that can lead to splenic rupture include mononucleosis, malaria, and in rare cases HIV | <h2> Associated Co-morbidities </h2> | ||
<p>Common co-morbidities for traumatic splenic ruptures are hypertension, type II diabetes, and asthma. In a study involving 538 subjects, 25% suffered from one or more of the co-morbilities listed above. <span class="fck_mw_ref">Clancy A, Tiruta C, Ashman D, Ball C, Kirkpatrick A. The song remains the same although the instruments are changing: complications following selective non-operative management of blunt spleen trauma: a retrospective review of patients at a level I trauma centre from 1996 to 2007. Journal of Trauma Management &amp;amp;amp;amp;amp;amp; Outcomes 2012; ISSN 1752-2897</span> | |||
Other conditions that can lead to splenic include drug addiction, sickle cell disease, and prolonged use of blood thinners.<br> | </p><p>Non-traumatic splenic ruptures can be associated with numerous conditions and diseases. Some of the most common include, lymphoma, cirrhosis of the liver, liver disease, pancreatic pathology, bone marrow disorders such as leukaemia, and blood clotting disorders. | ||
</p><p>Viral diseases that can lead to splenic rupture include mononucleosis, malaria, and in rare cases HIV | |||
</p><p>Other conditions that can lead to splenic include drug addiction, sickle cell disease, and prolonged use of blood thinners.<br /> | |||
</p> | |||
<h2> Medications </h2> | |||
<p>No medications are prescribed to heal severe splenic ruptures, there are medications and vaccines recommended post-surgical removal of the spleen (splenectomy) in severe injuries. | |||
</p><p>The Advisory Committee on Immunization Practices for the Centers for Disease Control and Prevention (CDC) and the Society of Surgery for the Alimentary Tract recommends all patients that undergo splenectomy receive: <span class="fck_mw_ref">Webb C, Crowell K. Which vaccinations are indicated after splenectomy? Journal of Family Practice 2006;55:8. http://www.jfponline.com/Pages.asp?AID=4327&amp;amp;amp;amp;amp;amp;amp;amp;amp;issue=August%202006&amp;amp;amp;amp;amp;amp;amp;amp;amp;UID= (accessed 26 Marc 2012)</span> | |||
</p><p>• the pneumococcal polysaccharide vaccine <br />• meningococcal vaccination<br />• considered for the Hib vaccine<br />• annual influenza vaccine in addition to the pneumococcal, meningococcal, and Hib vaccines, because secondary bacterial infections can lead to severe disease in this patient population<br />• boosters for all the bacterial vaccines every 5 years<br /> | |||
</p> | |||
<h2> Diagnostic Tests/Lab Tests/Lab Values </h2> | |||
<p>The most common test used to diagnosis splenic rupture is computed tomography (CT) which can be supplemented by x-ray. <br /> | |||
</p><p><b>Grades of Splenic Injury</b> | |||
</p> | |||
<table style="width: 509px; height: 129px;" border="1" cellspacing="1" cellpadding="1"> | |||
<tr> | |||
<td> Grades | |||
</td><td> Extent of Splenic Injury | |||
</td></tr> | |||
<tr> | |||
<td> Grade 1 | |||
</td><td> | |||
<p>Hematoma; subcapular, non expanding, <10% of surface area | |||
</p><p>Laceration: capsular tear, non bleeding, <1 cm of parenchymal depth | |||
</p> | |||
</td></tr> | |||
<tr> | |||
<td> Grade 2 | |||
</td><td> | |||
<p>Hematoma, subcapular, non expanding, 10-50% of surace area, intraparenchyma, non expanding, <2 cm in diameter | |||
</p><p>Laceration: capsular tear, active bleeding, 1-3 cm of parenchymal depth that does not involve a trabecular vessel | |||
</p> | |||
</td></tr> | |||
<tr> | |||
<td> Grade 3 | |||
</td><td> | |||
<p>Hematoma: subcapular >50% of surface area or expanding, ruptured subscapuar hematoma with active bleeding, intraparenchymal hematoma, >2 cm or expanding | |||
</p><p>Lacertation > 3 cm of parenchymal depth or involving trabecular vessels | |||
</p> | |||
</td></tr> | |||
<tr> | |||
<td> Grade 4 | |||
</td><td> | |||
<p>Hematoma: ruptured intraparenchymal hematoma with active bleeding | |||
</p><p>Laceration: laceration involving segmental or hilar vessel producing major devascularization (>25% of spleen) | |||
</p> | |||
</td></tr> | |||
<tr> | |||
<td> Grade 5 | |||
</td><td> | |||
Hematoma: | <p>Hematoma: completely ruptured spleen | ||
</p><p>Laceration: hilar vascular injury that devacularizes spleen | |||
</p> | |||
</td></tr></table> | |||
<p>Table Reference<span class="fck_mw_ref">EB Medicine, Splenic Injuries: http://www.ebmedicine.net/topics.php?paction=showTopicSeg&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;topic_id=132&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;seg_id=2728</span><br /> | |||
</p><p><br /> | |||
</p><p><img src="/images/0/07/Grade_I.jpg" _fck_mw_filename="Grade I.jpg" _fck_mw_width="164" _fck_mw_height="226" alt="" /> | |||
Hematoma: ruptured | </p><p>Spleen, trauma. Chest radiograph shows a peripherally calcified mass in the left upper quadrant under the diaphragm. The mass represents a calcified splenic hematoma.<span class="fck_mw_ref">Klepac S. Spleen Trauma Imaging. Medscape.http://emedicine.medscape.com/article/373694-overview (accessed 22 March 2012).</span> <br /> | ||
</p><p><br /> | |||
Laceration: | </p><p><img src="/images/5/50/Grade_II.jpg" _fck_mw_filename="Grade II.jpg" _fck_mw_width="236" _fck_mw_height="174" alt="" /> | ||
</p><p>Spleen, trauma. Contrast-enhanced CT scan shows a localized area of dense contrast collection in the splenic hilum, with a massive amount of surrounding fluid/blood. Findings here are indicative of active extravasation of contrast in a patient with traumatic autosplenectomy. This is a grade V injury.<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Medscape" /><br /><br /> | |||
</p><p><br /> | |||
</p><p><img src="/images/thumb/0/04/Grade_III.jpg/323px-Grade_III.jpg" _fck_mw_filename="Grade III.jpg" _fck_mw_width="324" _fck_mw_height="215" alt="" /> | |||
</p><p>Grade I - Subcapsular hematoma of less than 10% of surface area. Capsular tear of less than 1 cm in depth.<span class="fck_mw_ref">Johnson J, Splenic Injury AAST Grading System. UVMRads. UVMRads. http://uvmrads.org/sections/bodyct/87-splenic-injury-aast-grading-system?start=1 (accessed 23 March 2012</span><br /><br /> | |||
</p><p><br /> | |||
</p><p><img src="/images/thumb/5/59/Grade_IV.jpg/321px-Grade_IV.jpg" _fck_mw_filename="Grade IV.jpg" _fck_mw_width="322" _fck_mw_height="214" alt="" /> | |||
</p><p>Grade III - Subcapsular hematoma of greater than 50% of surface area or expanding and ruptured subcapsular or parenchymal hematoma. Intraparenchymal hematoma of greater than 5 cm or expanding. Laceration of greater than 3 cm in depth or involving trabecular vessels. <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="UVMRads" /><br /><br /> | |||
</p><p><br /> | |||
</p><p><img src="/images/thumb/e/e2/Grade_V.jpg/325px-Grade_V.jpg" _fck_mw_filename="Grade V.jpg" _fck_mw_width="325" _fck_mw_height="216" alt="" /> | |||
</p><p>Grade V - Shattered spleen or hilar vascular injury <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="UVMRads" /><br /><br /> | |||
</p> | |||
<h2> Etiology/Causes </h2> | |||
<br> | <p><b><u>Traumatic</u></b>(common) <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Mayo Clinic" /><br />• Injury or blow to left side of the body (left upper abdomen or left lower chest)<br />• Sports related<br />• Fights/Assaults<br />• Motor vehicle accidents<br />• Falls<br /><br /><u><b>Atraumatic</b></u>(uncommon and diagnosis is often missed due to absence of any history of trauma)<br /> | ||
</p><p><img src="/images/2/26/Table_12.png" _fck_mw_filename="Table 12.png" alt="" /><br /> | |||
</p><p><br /> | |||
</p><p><span class="fck_mw_ref">Debnath D, Valerio D. Education- Atraumatic rupture of the spleen in adults. J.R. Coll.Surg.Edinb. 2002;47;437-445. http://www.rcsed.ac.uk/journal/vol47_1/47100010.html (accessed 28 Mar 2012)</span><br /> | |||
</p><p>http://www.rcsed.ac.uk/journal/vol47_1/47100010.html<br /> | |||
</p><p><img src="/images/thumb/f/fc/Atraumatic_Schematic.png/721px-Atraumatic_Schematic.png" _fck_mw_filename="Atraumatic Schematic.png" _fck_mw_width="721" _fck_mw_height="416" alt="" /> | |||
</p><p><span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Atraumatic Spleen" /> | |||
</p><p>http://www.rcsed.ac.uk/journal/vol47_1/47100010.html<br /> | |||
</p> | |||
<h2> Systemic Involvement </h2> | |||
<p>Rupture of the spleen can lead to life threatening bleeding into the abdominal cavity, which will lead to low blood pressure and decreased oxygen supply to the heart and brain. It is a medical emergency and should be referred to the emergency room immediately.<br /> | |||
</p> | |||
< | |||
Grade III - Subcapsular hematoma of | |||
Rupture of the spleen can lead to life threatening bleeding into the abdominal cavity, which will lead to low blood pressure and decreased oxygen supply to the heart and brain. It is a medical emergency and should be referred to the emergency room immediately.<br> | |||
<div style="" id="wrc-float-icon"></div> | <div style="" id="wrc-float-icon"></div> | ||
<h2> Medical Management (current best evidence) </h2> | |||
<p>First case control study on operative vs. non-operative management by Upadhyaya and Simpson in 1968 suggested that isolated splenic injuries could be safely treated without surgery in children. Pediatric surgeons led the way during the following decades, and non-operative management is now reported to be successful in more than 90 percent of children with isolated blunt injuries.<span class="fck_mw_ref">Skattum J, Naess P, Gaarder C. Non-operative management and immune function after splenic injury. BJS 2011;99:1;59-65. http://onlinelibrary.wiley.com/doi/10.1002/bjs.7764/abstract (accessed 28 Mar 2012)</span> | |||
First case control study on operative vs. non-operative management by Upadhyaya and Simpson in 1968 suggested that isolated splenic injuries could be safely treated without surgery in children. Pediatric surgeons led the way during the following decades, and non-operative management is now reported to be successful in more than 90 percent of children with isolated blunt injuries.< | </p><p><br /> | ||
</p><p><b><u>Non-Operative Management (NOM)</u></b><br />• Non-operative management may require: <span class="fck_mw_ref">MD Guidlelines, Rupture of Spleen Traumatic. fckLRhttp://www.mdguidelines.com/rupture-of-spleen-traumatic (accessed 20 Mar 2012)</span><br />• <b>Significant blood transfusions<br />• Repeated CT scans <br />• Hematocrits (a centrifuge for separating blood cells from plasma)<br />• Close observation for up to 2 weeks, including an initial period of observation in intensive care.</b> | |||
<br> | </p><p>• Non-Operative treatment is attempted in 60-90% of patients with blunt traumatic splenic injuries with intent to preserve splenic function <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" /> | ||
</p><p>• Spleen preserving surgery gained popularity in 1960’s due to the discovery of the spleens role in immune function <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" /><br /> | |||
</p><p>• Predictors and other risk factors associated with failure of non-operative management: <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" /> | |||
</p><p><b>• Hemodynamic instability:</b><br />o systolic blood pressure less than 100 mm Hg<br />o heart rate greater than 120 beats per minute <br />o lack of response to a fluid challenge of 2 L of a crystalloid solution | |||
• Non-Operative treatment is attempted in 60-90% of patients with blunt traumatic splenic injuries with intent to preserve splenic function | </p><p>•<b>Contrast Extravasation</b>: <br />o A leakage of contrast material into the fatty tissue around a vein. Contrast is a dye that allows your veins and arteries to show up more clearly on the CT/MRI scan <span class="fck_mw_ref">University of Washington, Radiology and Imaging Services. http://uwmedicine.washington.edu/Patient-Care/Our-Services/Medical-Services/Radiology-Imaging-Services/Pages/Contrast-Extravasation.aspx (accessed 21 Mar 2012)</span> | ||
</p><p><b>• Arteriovenous Fistula:</b><br />o abnormal connection between an artery and a vein <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Mayo Clinic" /> | |||
• Spleen preserving surgery gained popularity in 1960’s due to the discovery of the spleens role in immune function | </p><p><b>• Pseudoaneurysm: </b><br />o false aneurysm | ||
</p><p><b>• Large volume of blood in peritoneum cavity</b> | |||
• Predictors and other risk factors associated with failure of non-operative management: | </p><p><b>• age over 55 years</b> | ||
</p><p><b>• multiple injuries</b><br /> | |||
</p><p>• Angioembolization is an adjunct to non-operative management and generally reported to increase the success rate of non-operative management approaching 95 percent <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" /><br /> | |||
</p><p><img src="/images/thumb/b/bb/Angioembolism_Pics.docx.png/703px-Angioembolism_Pics.docx.png" _fck_mw_filename="Angioembolism Pics.docx.png" _fck_mw_width="703" _fck_mw_height="395" alt="" /> | |||
• | </p><p>http://onlinelibrary.wiley.com/doi/10.1002/bjs.7764/abstract <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" /><br /> | ||
</p><p><br />• In angiographic embolization, coils or pledgets are used to reduce splenic hemorrhage, by occlusion either of the proximal splenic artery or of more distal branches (Fig.2a,b). Proximal splenic artery embolization is thought to reduce the perfusion pressure in the spleen, thereby stopping bleeding and the risk of delayed rupture or rebleeding. Peripheral embolization stops bleeding more selectively and occludes pseudoaneurysms or arteriovenous fistulas <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" /><br /> | |||
</p><p><br /> | |||
</p><p><u><b>Operative Management (OM)</b></u><br />• <b>Splenectomy</b><br />• Performed most splenic injuries up to 1950<br />• Complete removal of spleen<br />• Most appropriate procedure for unstable patients <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" /><br />• Laproscopic and Open procudures<br />• Prone to infections | |||
</p><p><br />• <span class="fck_mw_template"><span class="fck_mw_template">{{#ev:youtube|Jk3lhKdHCpg}}</span></span> <br /> | |||
</p><p><br /><b>• Splenorrhaphy</b><br />• Suturing the spleen and non-removal<br />• Performed approximately 6% of the time (anything new in adult splenic ruptures)<br />• Grade 3 spleen injury - mesh splenorrhaphy<br /> | |||
</p><p><br /> | |||
</p><p><img src="/images/e/ec/Splenorrhaphy.png" _fck_mw_filename="Splenorrhaphy.png" _fck_mw_width="200" _fck_mw_height="150" alt="" /> | |||
</p><p><span class="fck_mw_ref">Trauma.org. Care for the Injured- Massotto H. Grade 3 spleen prevention-mesh splenorrhaphy. Available: http://www.trauma.org/index.php/main/images_keyword/laparotomy (assessed 30 Mar 2012)</span><br /> | |||
</p><p>http://www.trauma.org/index.php/main/images_keyword/laparotomy/<br /> | |||
</p> | |||
<h2> Physical Therapy Management (current best evidence) </h2> | |||
• Angioembolization is an adjunct to non-operative management and generally reported to increase the success rate of non-operative management approaching 95 percent | <p>Physical therapist must be able to recognize the signs and symptoms of spleen rupture. In sports, splenic rupture is the most common cause of death due to abdominal trauma, it is vital that clinicians perform a through exam of the patient.<span class="fck_mw_ref">Shultz SJ, Houglum PA, Perrin DH. Examination of Musculoskeletal Injuries, 2nd ed. Champaign, IL, 2005. p. 570-571</span><br /> | ||
</p><p>Palpation - The spleen is located in the left upper quadrant and covered by the 9th - 11th ribs. Clinicians should check this area for pain and tenderness. Abdominal palpation should also be performed in the hook-lying position checking for tenderness, distension, guarding, and rebound tenderness. "To palpate the spleen, lift the left flank with your nondominant hand; keeping your other hand flat, depress the palpating digits just below and anteriro to the 11th and 12 ribs and ask the patient to take a deep breath. A normal healthy spleen should not be palpable." <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Shultz" /> | |||
</p><p>Patient Education - Most splenic ruptures can be rapidly progressing, while others can delay hemmorrhage for hours, days, or even weeks after injury, until a suffient enough force causes rupture. It is vital that we education patients about the signs and symptoms so they can seek medical care immediately. | |||
</p><p>Post-operation: encourage ROM, ambulation, and coughing techniques (splinted coughing). Most traumatic splenic ruptures will not be seen in physical therapy.<br /> | |||
</p> | |||
<h2> Differential Diagnosis </h2> | |||
< | <p>Left kidney trauma/pathology<br /> | ||
</p><p>Rib fracture | |||
< | </p><p>Intestinal pathology | ||
</p><p>Musculoskeletal Involvement | |||
</p> | |||
<h2> Case Reports/ Case Studies<br /> </h2> | |||
<p>Third-Degree Spleen Laceration in a Male Varsity Athlete | |||
</p><p>http://journals.humankinetics.com/att-back-issues/attvolume8issue3may | |||
</p><p>Splenic Rupture in Infectious Mononucleosis | |||
</p><p>http://www.annals.org/content/46/6/1184.short | |||
<br> | </p><p>Spontaneous rupture of the spleen – a fatal complication of pregnancy | ||
</p><p>http://www.ncbi.nlm.nih.gov/pubmed/7572867 | |||
</p><p><br /> | |||
</p><p><u><b>Case Report</b></u> | |||
< | </p><p><i>Philippe E. Fait, Richard DeMont. Third-degree spleen laceration<br />in a male varsity athlete. Athletic Therapy Today. 2003; 8; 32-33</i> | ||
</p><p><br /> | |||
</p><p><b>Patient</b>:<br />-23 year old male university hockey player "Eric"<br />-Collided with another player and then got up and skated to the bench but had extreme difficulty breathing<br />-They performed a bench and concussion evaluation and the player was deemed “winded” and cleared to play<br />-Not long after getting back out there he complained of general body pain<br />-They took him into the locker room where he immediately began vomiting | |||
</p><p><b>Physician Evaluation and Dx:</b><br />-no rib fractures<br />-Kehr’s sign= suspected spleen damage yet not 100% certain b/c he had prior shoulder surgery the previous year | |||
</p><p><b>Tests</b>:<br />-Xray and then sent home | |||
</p><p><b>Next Day:</b><br />-Felt worse so parents took him back to hospital<br />-Admitted to intensive care dept<br />-CT revealed a 3rd degree spleen laceration | |||
</p><p><b>Care and Treatment:</b><br />-Usual conservative (nonsurgical) trx - 1 week hospitalization<br />-Prescribed a 6 month recovery before returning to hockey<br />-At 2 months-light to medium physical activity and a CT scan<br />-At 4 months- follow up assessment, intense physical noncontact training began<br />-At 6 months- full contact was permitted | |||
</p><p><b>Prognosis:</b><br />-At 5 months postinjury-<br />-engaged in regular gym workouts <br />-returned to a normal diet<br />-lost considerable weight | |||
</p> | |||
<ul><li>Player continued a conservative approach to return to sport in that he decided to not to play varsity hockey the following season, taking at least 1 year off.<br /><br /> | |||
</li></ul> | |||
<div id="wrc-float-icon" style=""></div> | <div id="wrc-float-icon" style=""></div> | ||
<h2> Resources <br /> </h2> | |||
<p>1. Mayo Clinic<br />http://www.mayoclinic.com/health/ruptured-spleen/DS00872 | |||
1. Mayo Clinic<br>http://www.mayoclinic.com/health/ruptured-spleen/DS00872 | </p><p>2. Medscape<br />http://emedicine.medscape.com/article/432823-treatment | ||
</p><p>3. Discussion Board Spleen Rupture<br />http://www.medhelp.org/tags/show/148977/rupture-spleen | |||
2. Medscape<br>http://emedicine.medscape.com/article/432823-treatment | </p><p>http://www.healthboards.com/boards/general-health/698344-rib-cage-injury-ruptured-spleen.html | ||
</p> | |||
3. Discussion Board Spleen Rupture<br>http://www.medhelp.org/tags/show/148977/rupture-spleen | <h2> Recent Related Research (from <a href="http://www.ncbi.nlm.nih.gov/pubmed/">Pubmed</a>) </h2> | ||
<p>see tutorial on <a href="Adding PubMed Feed">Adding PubMed Feed</a> | |||
http://www.healthboards.com/boards/general-health/698344-rib-cage-injury-ruptured-spleen.html | </p> | ||
see tutorial on | |||
<div class="researchbox"> | <div class="researchbox"> | ||
< | <p><span class="fck_mw_special">http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1tYbWOIP0tI0rcUJrEZlcEvYw6v8cNAf2PUUAlTae95SAWDgH4|charset=UTF-8|short|max=10</span> | ||
</p> | |||
</div> | </div> | ||
<h2> References </h2> | |||
<p>see <a href="Adding References">adding references tutorial</a>. | |||
see | </p><p><span class="fck_mw_references" _fck_mw_customtag="true" _fck_mw_tagname="references" /> | ||
</p><a _fcknotitle="true" href="Category:Bellarmine_Student_Project">Bellarmine_Student_Project</a> <a _fcknotitle="true" href="Category:Medical">Medical</a> <a _fcknotitle="true" href="Category:Sports_Injuries">Sports_Injuries</a> | |||
< | |||
Revision as of 23:08, 13 April 2017
Original Editors - Nick Hansen & Ren Peterson <a href="Pathophysiology of Complex Patient Problems">from Bellarmine University's Pathophysiology of Complex Patient Problems project.</a>
Top Contributors - Nicholaus Hansen, Taylor Hutchison, Vidya Acharya, Kim Jackson, Michael Flores, Lucinda hampton, Admin, Elaine Lonnemann, Claire Knott, 127.0.0.1, WikiSysop, Wendy Walker and Naomi O'Reilly
Definition/Description
The spleen is an organ of the lymphatic system located on the left side of your stomach (abdomen) under the rib cage and diaphragm in a region that is referred to as the left upper quadrant. In humans the spleen is about the size of a fist and its primary roles are filtering the body’s blood and helps to fight infection. It also serves a role in storing and releasing certain types of immune cells that mediate tissue inflammation Encyclopædia Britannica. Encyclopædia Britannica Online Academic Edition. Encyclopædia Britannica Inc.,. Spleen. Available from: http://www.britannica.com/EBchecked/topic/560613/spleen
Rupturing a spleen describes an emergency situation in which your spleen has developed a break in its surface. This is serious condition that can occur during a direct blow or trauma and without emergency treatment a ruptured spleen can cause life threatening internal bleeding. Mayo Foundation for Medical Education and Research (MFMER) 1998-2012. Ruptured Spleen. [Internet] 2012 [updated 2010 Nov 19; cited 2012 Mar 30]. Available from: http://www.mayoclinic.com/health/ruptured-spleen/DS00872
Prevalence
The prevalence of splenic ruptures are poorly documented but one study suggest that traumatic splenic ruptures are more likely to occur in males (2:1 male to female) with ages ranging from 18-34 years.<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Atraumatic Spleen" />
Infectious Mononucleosis – Annually in the United States there are appropriately 345 – 671 cases per 100,000. Typically involving school age children ages 13-19 years. Approximately 0.1% to 0.2% of the 345 – 671 cases in the United States will suffer from splenic ruptures. “Base on this figure, approximately 100 cases of ruptures may occur yearly in the US, only a few of which are reported.” Foreman B, Mackler L. Can we prevent splenic rupture for patients with infectious mononucleosis? Journal of Family Practice 2005; 54: 547
Characteristics/Clinical Presentation
Signs and symptoms of a ruptured spleen includes: <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Mayo Clinic" />
• Pain (usually severe but not always) in the upper left portion of the stomach (abdomen) or under rib cage
• Tenderness when you touch the upper left portion of the stomach (abdomen)
• Left shoulder pain-Kehr’s Sign
- Internal bleeding due to a ruptured spleen can cause blood pressure to drop (hypotension). ↑ WebMD. 2005-2012. Ruptured Spleen. [Internet] [reviewed 2009 Aug 19; cited 2012 Mar 30]. Available from: http://www.webmd.com/digestive-disorders/ruptured-spleen
- Internal bleeding:
- Blurred vision
- Confusion
- Light-headedness
- Fainting
- Signs of shock (cold clammy skin, pale, weak or rapid pulse)
Kehr's sign (Hans Kehr (1862–1913),
- pain in the left shoulder caused by irritation of the undersurface of the diaphragm by blood leaking from a ruptured spleen. The pain impulses are referred along the phrenic nerve supplying the diaphragm C3-C5 nerve distribution. A Dictionary of Nursing. 2008. Kehr’s Sign. 29 Mar. 2012 Available at: http://www.encyclopedia.com/doc/1O62-Kehrssign.html.
- • Video of Kehr’s Sign:
https://www.youtube.com/watch?v=UkXghZn2WJ8 https://www.youtube.com/watch?v=UkXghZn2WJ8
Castell’s Percussion Test: Clinical Screen for the presence of splenic inflammation.
• Patient Supine
• Clinician palpates the left costal margin near the anterior axillary line.
• Clinician then instructs the patient to breathe normally while they apply percussion at both full inspiration as well as at rest.
• Findings: Positive test if dull sound is present upon full inspiration and expiration. (Indicates spleen descending)
• Normal it is only dull at full inspriation and should be tympanic at rest.
• Important: If spleen is found to be inflamed, DO NOT continue to palpate as it can lead to a rupture. Examination of the Spleen. Examination of the Spleen | Stanford Medicine 25 | Stanford Medicine. http://stanfordmedicine25.stanford.edu/the25/spleen.html. Accessed April 4, 2017.
It is strongly advised to seek immediate medical care if an injury is sustained coupled with pain in the left upper stomach (abdomen) region along with any of the above listed signs and symptoms. If severe injuries are untreated a ruptured spleen can be fatal.
Associated Co-morbidities
Common co-morbidities for traumatic splenic ruptures are hypertension, type II diabetes, and asthma. In a study involving 538 subjects, 25% suffered from one or more of the co-morbilities listed above. Clancy A, Tiruta C, Ashman D, Ball C, Kirkpatrick A. The song remains the same although the instruments are changing: complications following selective non-operative management of blunt spleen trauma: a retrospective review of patients at a level I trauma centre from 1996 to 2007. Journal of Trauma Management &amp;amp;amp;amp;amp; Outcomes 2012; ISSN 1752-2897
Non-traumatic splenic ruptures can be associated with numerous conditions and diseases. Some of the most common include, lymphoma, cirrhosis of the liver, liver disease, pancreatic pathology, bone marrow disorders such as leukaemia, and blood clotting disorders.
Viral diseases that can lead to splenic rupture include mononucleosis, malaria, and in rare cases HIV
Other conditions that can lead to splenic include drug addiction, sickle cell disease, and prolonged use of blood thinners.
Medications
No medications are prescribed to heal severe splenic ruptures, there are medications and vaccines recommended post-surgical removal of the spleen (splenectomy) in severe injuries.
The Advisory Committee on Immunization Practices for the Centers for Disease Control and Prevention (CDC) and the Society of Surgery for the Alimentary Tract recommends all patients that undergo splenectomy receive: Webb C, Crowell K. Which vaccinations are indicated after splenectomy? Journal of Family Practice 2006;55:8. http://www.jfponline.com/Pages.asp?AID=4327&amp;amp;amp;amp;amp;amp;amp;amp;issue=August%202006&amp;amp;amp;amp;amp;amp;amp;amp;UID= (accessed 26 Marc 2012)
• the pneumococcal polysaccharide vaccine
• meningococcal vaccination
• considered for the Hib vaccine
• annual influenza vaccine in addition to the pneumococcal, meningococcal, and Hib vaccines, because secondary bacterial infections can lead to severe disease in this patient population
• boosters for all the bacterial vaccines every 5 years
Diagnostic Tests/Lab Tests/Lab Values
The most common test used to diagnosis splenic rupture is computed tomography (CT) which can be supplemented by x-ray.
Grades of Splenic Injury
Grades | Extent of Splenic Injury |
Grade 1 |
Hematoma; subcapular, non expanding, <10% of surface area Laceration: capsular tear, non bleeding, <1 cm of parenchymal depth |
Grade 2 |
Hematoma, subcapular, non expanding, 10-50% of surace area, intraparenchyma, non expanding, <2 cm in diameter Laceration: capsular tear, active bleeding, 1-3 cm of parenchymal depth that does not involve a trabecular vessel |
Grade 3 |
Hematoma: subcapular >50% of surface area or expanding, ruptured subscapuar hematoma with active bleeding, intraparenchymal hematoma, >2 cm or expanding Lacertation > 3 cm of parenchymal depth or involving trabecular vessels |
Grade 4 |
Hematoma: ruptured intraparenchymal hematoma with active bleeding Laceration: laceration involving segmental or hilar vessel producing major devascularization (>25% of spleen) |
Grade 5 |
Hematoma: completely ruptured spleen Laceration: hilar vascular injury that devacularizes spleen |
Table ReferenceEB Medicine, Splenic Injuries: http://www.ebmedicine.net/topics.php?paction=showTopicSeg&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;topic_id=132&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;seg_id=2728
<img src="/images/0/07/Grade_I.jpg" _fck_mw_filename="Grade I.jpg" _fck_mw_width="164" _fck_mw_height="226" alt="" />
Spleen, trauma. Chest radiograph shows a peripherally calcified mass in the left upper quadrant under the diaphragm. The mass represents a calcified splenic hematoma.Klepac S. Spleen Trauma Imaging. Medscape.http://emedicine.medscape.com/article/373694-overview (accessed 22 March 2012).
<img src="/images/5/50/Grade_II.jpg" _fck_mw_filename="Grade II.jpg" _fck_mw_width="236" _fck_mw_height="174" alt="" />
Spleen, trauma. Contrast-enhanced CT scan shows a localized area of dense contrast collection in the splenic hilum, with a massive amount of surrounding fluid/blood. Findings here are indicative of active extravasation of contrast in a patient with traumatic autosplenectomy. This is a grade V injury.<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Medscape" />
<img src="/images/thumb/0/04/Grade_III.jpg/323px-Grade_III.jpg" _fck_mw_filename="Grade III.jpg" _fck_mw_width="324" _fck_mw_height="215" alt="" />
Grade I - Subcapsular hematoma of less than 10% of surface area. Capsular tear of less than 1 cm in depth.Johnson J, Splenic Injury AAST Grading System. UVMRads. UVMRads. http://uvmrads.org/sections/bodyct/87-splenic-injury-aast-grading-system?start=1 (accessed 23 March 2012
<img src="/images/thumb/5/59/Grade_IV.jpg/321px-Grade_IV.jpg" _fck_mw_filename="Grade IV.jpg" _fck_mw_width="322" _fck_mw_height="214" alt="" />
Grade III - Subcapsular hematoma of greater than 50% of surface area or expanding and ruptured subcapsular or parenchymal hematoma. Intraparenchymal hematoma of greater than 5 cm or expanding. Laceration of greater than 3 cm in depth or involving trabecular vessels. <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="UVMRads" />
<img src="/images/thumb/e/e2/Grade_V.jpg/325px-Grade_V.jpg" _fck_mw_filename="Grade V.jpg" _fck_mw_width="325" _fck_mw_height="216" alt="" />
Grade V - Shattered spleen or hilar vascular injury <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="UVMRads" />
Etiology/Causes
Traumatic(common) <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Mayo Clinic" />
• Injury or blow to left side of the body (left upper abdomen or left lower chest)
• Sports related
• Fights/Assaults
• Motor vehicle accidents
• Falls
Atraumatic(uncommon and diagnosis is often missed due to absence of any history of trauma)
<img src="/images/2/26/Table_12.png" _fck_mw_filename="Table 12.png" alt="" />
Debnath D, Valerio D. Education- Atraumatic rupture of the spleen in adults. J.R. Coll.Surg.Edinb. 2002;47;437-445. http://www.rcsed.ac.uk/journal/vol47_1/47100010.html (accessed 28 Mar 2012)
http://www.rcsed.ac.uk/journal/vol47_1/47100010.html
<img src="/images/thumb/f/fc/Atraumatic_Schematic.png/721px-Atraumatic_Schematic.png" _fck_mw_filename="Atraumatic Schematic.png" _fck_mw_width="721" _fck_mw_height="416" alt="" />
<span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Atraumatic Spleen" />
http://www.rcsed.ac.uk/journal/vol47_1/47100010.html
Systemic Involvement
Rupture of the spleen can lead to life threatening bleeding into the abdominal cavity, which will lead to low blood pressure and decreased oxygen supply to the heart and brain. It is a medical emergency and should be referred to the emergency room immediately.
Medical Management (current best evidence)
First case control study on operative vs. non-operative management by Upadhyaya and Simpson in 1968 suggested that isolated splenic injuries could be safely treated without surgery in children. Pediatric surgeons led the way during the following decades, and non-operative management is now reported to be successful in more than 90 percent of children with isolated blunt injuries.Skattum J, Naess P, Gaarder C. Non-operative management and immune function after splenic injury. BJS 2011;99:1;59-65. http://onlinelibrary.wiley.com/doi/10.1002/bjs.7764/abstract (accessed 28 Mar 2012)
Non-Operative Management (NOM)
• Non-operative management may require: MD Guidlelines, Rupture of Spleen Traumatic. fckLRhttp://www.mdguidelines.com/rupture-of-spleen-traumatic (accessed 20 Mar 2012)
• Significant blood transfusions
• Repeated CT scans
• Hematocrits (a centrifuge for separating blood cells from plasma)
• Close observation for up to 2 weeks, including an initial period of observation in intensive care.
• Non-Operative treatment is attempted in 60-90% of patients with blunt traumatic splenic injuries with intent to preserve splenic function <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" />
• Spleen preserving surgery gained popularity in 1960’s due to the discovery of the spleens role in immune function <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" />
• Predictors and other risk factors associated with failure of non-operative management: <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" />
• Hemodynamic instability:
o systolic blood pressure less than 100 mm Hg
o heart rate greater than 120 beats per minute
o lack of response to a fluid challenge of 2 L of a crystalloid solution
•Contrast Extravasation:
o A leakage of contrast material into the fatty tissue around a vein. Contrast is a dye that allows your veins and arteries to show up more clearly on the CT/MRI scan University of Washington, Radiology and Imaging Services. http://uwmedicine.washington.edu/Patient-Care/Our-Services/Medical-Services/Radiology-Imaging-Services/Pages/Contrast-Extravasation.aspx (accessed 21 Mar 2012)
• Arteriovenous Fistula:
o abnormal connection between an artery and a vein <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Mayo Clinic" />
• Pseudoaneurysm:
o false aneurysm
• Large volume of blood in peritoneum cavity
• age over 55 years
• multiple injuries
• Angioembolization is an adjunct to non-operative management and generally reported to increase the success rate of non-operative management approaching 95 percent <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" />
<img src="/images/thumb/b/bb/Angioembolism_Pics.docx.png/703px-Angioembolism_Pics.docx.png" _fck_mw_filename="Angioembolism Pics.docx.png" _fck_mw_width="703" _fck_mw_height="395" alt="" />
http://onlinelibrary.wiley.com/doi/10.1002/bjs.7764/abstract <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" />
• In angiographic embolization, coils or pledgets are used to reduce splenic hemorrhage, by occlusion either of the proximal splenic artery or of more distal branches (Fig.2a,b). Proximal splenic artery embolization is thought to reduce the perfusion pressure in the spleen, thereby stopping bleeding and the risk of delayed rupture or rebleeding. Peripheral embolization stops bleeding more selectively and occludes pseudoaneurysms or arteriovenous fistulas <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" />
Operative Management (OM)
• Splenectomy
• Performed most splenic injuries up to 1950
• Complete removal of spleen
• Most appropriate procedure for unstable patients <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Management" />
• Laproscopic and Open procudures
• Prone to infections
•
• Splenorrhaphy
• Suturing the spleen and non-removal
• Performed approximately 6% of the time (anything new in adult splenic ruptures)
• Grade 3 spleen injury - mesh splenorrhaphy
<img src="/images/e/ec/Splenorrhaphy.png" _fck_mw_filename="Splenorrhaphy.png" _fck_mw_width="200" _fck_mw_height="150" alt="" />
Trauma.org. Care for the Injured- Massotto H. Grade 3 spleen prevention-mesh splenorrhaphy. Available: http://www.trauma.org/index.php/main/images_keyword/laparotomy (assessed 30 Mar 2012)
http://www.trauma.org/index.php/main/images_keyword/laparotomy/
Physical Therapy Management (current best evidence)
Physical therapist must be able to recognize the signs and symptoms of spleen rupture. In sports, splenic rupture is the most common cause of death due to abdominal trauma, it is vital that clinicians perform a through exam of the patient.Shultz SJ, Houglum PA, Perrin DH. Examination of Musculoskeletal Injuries, 2nd ed. Champaign, IL, 2005. p. 570-571
Palpation - The spleen is located in the left upper quadrant and covered by the 9th - 11th ribs. Clinicians should check this area for pain and tenderness. Abdominal palpation should also be performed in the hook-lying position checking for tenderness, distension, guarding, and rebound tenderness. "To palpate the spleen, lift the left flank with your nondominant hand; keeping your other hand flat, depress the palpating digits just below and anteriro to the 11th and 12 ribs and ask the patient to take a deep breath. A normal healthy spleen should not be palpable." <span class="fck_mw_ref" _fck_mw_customtag="true" _fck_mw_tagname="ref" name="Shultz" />
Patient Education - Most splenic ruptures can be rapidly progressing, while others can delay hemmorrhage for hours, days, or even weeks after injury, until a suffient enough force causes rupture. It is vital that we education patients about the signs and symptoms so they can seek medical care immediately.
Post-operation: encourage ROM, ambulation, and coughing techniques (splinted coughing). Most traumatic splenic ruptures will not be seen in physical therapy.
Differential Diagnosis
Left kidney trauma/pathology
Rib fracture
Intestinal pathology
Musculoskeletal Involvement
Case Reports/ Case Studies
Third-Degree Spleen Laceration in a Male Varsity Athlete
http://journals.humankinetics.com/att-back-issues/attvolume8issue3may
Splenic Rupture in Infectious Mononucleosis
http://www.annals.org/content/46/6/1184.short
Spontaneous rupture of the spleen – a fatal complication of pregnancy
http://www.ncbi.nlm.nih.gov/pubmed/7572867
Case Report
Philippe E. Fait, Richard DeMont. Third-degree spleen laceration
in a male varsity athlete. Athletic Therapy Today. 2003; 8; 32-33
Patient:
-23 year old male university hockey player "Eric"
-Collided with another player and then got up and skated to the bench but had extreme difficulty breathing
-They performed a bench and concussion evaluation and the player was deemed “winded” and cleared to play
-Not long after getting back out there he complained of general body pain
-They took him into the locker room where he immediately began vomiting
Physician Evaluation and Dx:
-no rib fractures
-Kehr’s sign= suspected spleen damage yet not 100% certain b/c he had prior shoulder surgery the previous year
Tests:
-Xray and then sent home
Next Day:
-Felt worse so parents took him back to hospital
-Admitted to intensive care dept
-CT revealed a 3rd degree spleen laceration
Care and Treatment:
-Usual conservative (nonsurgical) trx - 1 week hospitalization
-Prescribed a 6 month recovery before returning to hockey
-At 2 months-light to medium physical activity and a CT scan
-At 4 months- follow up assessment, intense physical noncontact training began
-At 6 months- full contact was permitted
Prognosis:
-At 5 months postinjury-
-engaged in regular gym workouts
-returned to a normal diet
-lost considerable weight
- Player continued a conservative approach to return to sport in that he decided to not to play varsity hockey the following season, taking at least 1 year off.
Resources
1. Mayo Clinic
http://www.mayoclinic.com/health/ruptured-spleen/DS00872
2. Medscape
http://emedicine.medscape.com/article/432823-treatment
3. Discussion Board Spleen Rupture
http://www.medhelp.org/tags/show/148977/rupture-spleen
http://www.healthboards.com/boards/general-health/698344-rib-cage-injury-ruptured-spleen.html
Recent Related Research (from <a href="http://www.ncbi.nlm.nih.gov/pubmed/">Pubmed</a>)
see tutorial on <a href="Adding PubMed Feed">Adding PubMed Feed</a>
References
see <a href="Adding References">adding references tutorial</a>.
<span class="fck_mw_references" _fck_mw_customtag="true" _fck_mw_tagname="references" />
<a _fcknotitle="true" href="Category:Bellarmine_Student_Project">Bellarmine_Student_Project</a> <a _fcknotitle="true" href="Category:Medical">Medical</a> <a _fcknotitle="true" href="Category:Sports_Injuries">Sports_Injuries</a>