Ruptured Spleen

What is a ruptured spleen?

Your spleen is a tender, fist-sized organ in your upper left belly (abdomen). It’s primarily responsible for storing and filtering blood. It stores and filters 25% of your red blood cells and platelets at any given time, while helping to make white blood cells to fight infections. The inner “pulp” of the spleen that performs these functions is enclosed in a thin capsule of muscular tissue, with blood vessels passing through it.

The anatomy of your spleen makes it relatively easy to injure, especially by a blunt trauma to the outer capsule. If this capsule tears or splits, it’s called a splenic rupture. If your spleen ruptures, it's the most likely of all of your abdominal organs to cause life-threatening internal bleeding. A ruptured spleen is a medical emergency that requires swift diagnosis and intervention, and sometimes surgery.

What causes a spleen to rupture?

Traumatic injuries are the most common causes of splenic rupture, especially car accidents, which cause 50% to 75%. Sports injuries, especially in contact sports such as American football and hockey, are also common. Violent causes can include fist blows, stabbing and gunshot wounds. Your spleen may rupture immediately upon impact, or it may have a delayed rupture as a result of swelling from the injury.

Can a spleen rupture by itself?

Non-traumatic or spontaneous splenic rupture is rare but possible. It can happen when an underlying condition causes your spleen to swell, gradually weakening the outer capsule until it breaks. Conditions that can have this effect include:

• Cancer, such as lymphoma.
• Infections, such as mononucleosis or malaria.
• Chronic inflammatory diseases, such as hepatitis (liver disease) or pancreatitis.

What does a ruptured spleen feel like?

Your spleen is located in the upper left quadrant of your abdomen, under your left ribcage and diaphragm. At the moment of rupture, you’re likely to feel a distinct pain there. However, the types of injuries that can cause a ruptured spleen are likely to cause other trauma too — for example, a fractured rib. You may not be able to distinguish the feeling of a ruptured spleen from these other injuries.

After the moment of rupture, pain from your ruptured spleen may seem to move to the left side of your chest or your left shoulder. This is called Kehr’s sign. It happens because bleeding from your ruptured spleen can irritate a nerve that runs from your neck down through the left side of your chest (your left phrenic nerve). You may notice the pain is worse when you breathe in.

Are there other signs or symptoms of a ruptured spleen?

You may have symptoms related to blood loss and a rapid drop in blood pressure. These can include:

• Dizziness or lightheadedness.
• Mental confusion or disorientation.
• Blurred vision.
• Paleness and faintness.
• Restlessness or anxiety.
• Nausea.

What happens if you rupture your spleen?

If you have severe upper left abdominal pain or Kehr’s sign, even if it occurs sometime after your original injury, you should go straight to the emergency room. Call an ambulance if necessary. Tell the ER doctors about your symptoms and any recent injuries, infections or chronic diseases you’ve had. Your healthcare team will assess your condition and work to stabilize it with blood transfusion if necessary.

How is a ruptured spleen diagnosed?

If your condition is stable (your blood pressure and heart rate are close to normal) your healthcare team will examine you in a stepwise fashion, beginning with a physical exam and then progressing to imaging tests. If you’re in the emergency room with a traumatic injury, your healthcare team will begin with a special bedside ultrasound (FAST ultrasound) that looks for internal bleeding in your abdomen.

If your FAST ultrasound is positive and your vital signs remain unstable, your healthcare team will know that you have a ruptured spleen and need immediate treatment. If your condition is stable but your healthcare team suspects a splenic injury, they will often proceed with a CT scan to get a better look at your spleen and the extent of the injury. They will grade the injury on a scale of I to V.

How is a ruptured spleen treated?

Treatment depends on the extent of your injury. Some minor tears might stop bleeding on their own, while others may require various types of emergency repairs. Only the most severe (grade V) ruptures require spleen removal (splenectomy). However, a severe spleen injury might not be immediately obvious. Sometimes, a stable patient becomes unstable several hours later as the bleeding progresses.

Methods to treat a ruptured spleen may include:

• Embolization: For grade III and IV spleen injuries, splenic embolization can help manage the bleeding prior to or instead of surgery. Embolization is a non-surgical procedure that’s performed by an interventional radiologist. It uses radiology imaging techniques to guide a catheter into your blood vessel and inject tiny, sponge-like beads into it to stop the blood flow.
• Splenorrhaphy: Splenorrhaphy may be needed in addition to arterial embolization to manage grade III or IV injuries. Splenorrhaphy means surgical repair of the spleen. It might mean stitches or electrocautery to close the wound or applying topical agents to the wound to stop the bleeding. When this works, it can prevent the need for removing part or all of your spleen.
• Splenectomy: When severe bleeding can’t be controlled and the spleen can’t be preserved by any other means, it may be necessary to remove part or all of it. Only about 20% of spleen ruptures end this way. Since this is an emergency operation, it’s likely to be an open abdominal surgery. This gives your surgeon the best access to manage your urgent condition.

What are the chances of surviving a ruptured spleen?

The outcome depends on how severe your injury is and how quickly it gets diagnosed and treated. A minor rupture may only cause a small, slow bleed. This gives you more time, but it also makes it easier to overlook. A more severe bleed will usually be obvious in terms of your symptoms, but it's more dangerous. Severe internal bleeding can cause death within hours if it isn’t treated right away.

How long does it take to recover from a ruptured spleen?

Depending on the extent of your injury and treatment, it may take anywhere from three to 12 weeks to recover. If you have surgery, you’ll probably remain in the hospital for a few days afterward. Open abdominal surgery leaves you with a long incision wound to heal from. You may have a prescription for pain medication to take home. On the other hand, minor spleen injuries heal relatively quickly.

How should I take care of myself when I no longer have a spleen?

You can live without your spleen, but it will affect your immunity. Since your spleen plays an important role in protecting against infections, you may be more prone to getting sick after a splenectomy. Your surgeon will recommend some specific vaccines to protect you against infections in the hospital and afterward. They’ll also advise you to treat infections immediately with antibiotics if you do get sick.

A note from Cleveland Clinic

A ruptured spleen is an emergency, whether it's minor or severe. Any internal bleeding can be life-threatening if it isn’t managed. Fortunately, most splenic ruptures can be managed with conservative methods that spare your spleen. But this depends on recognizing and treating your injury quickly. If you suspect any injury to your spleen, seek medical attention right away to check it for bleeding.