The spleen is a small, unassuming organ tucked away beneath the rib cage that many people either haven’t heard of or don’t understand. Yet while we go about our day, the spleen silently performs numerous vital functions. And while you can technically live without a spleen, you would be at much greater risk for a variety of medical problems. The spleen is also somewhat delicate, and traumatic physical injuries to the body can damage the spleen and possibly cause it to rupture.

What Does the Spleen Do?

Located in the upper left quadrant of the abdomen, beneath the rib cage and behind the stomach, the spleen is a multifunction, fist-sized organ that is primarily part of the lymphatic system (which itself is part of the overall immune system). The highly vascular nature of the spleen makes it an important organ for the regulation of fluids and the filtration of blood. Below are the main functions of the spleen:

  • Blood filtration: One of the spleen’s most important functions is a filter for our blood cells. As blood passes through the organ, old and damaged red blood cells, platelets, and other potentially harmful components can be found in the bloodstream. In addition to maintaining the quality of circulating blood, the spleen recycles materials from old cells and promotes the production of new ones.
  • Blood storage: The spleen also acts as a reservoir for blood that can be released into circulation when needed; the most common example of this is when a traumatic injury occurs and the body experiences rapid blood loss. In such circumstances the spleen contracts and the backup blood gets added to circulation to maintain blood pressure.
  • Lymphocyte production: One of the ways the spleen assists immune system function is through the production of white blood cells (lymphocytes). White blood cells are the primary way the body recognizes and defends against pathogens in the body.
  • Phagocyte production: The spleen also contains another type of white blood cell called phagocytes; these specialized cells can actually engulf and destroy pathogens and thus are an important part of the immune system.
  • Fluid level balance: As blood flows through the spleen, the organ also helps maintain the body’s fluid balances. Via the spleen, the lymphatic system essentially collects excess fluid from tissues around the body and deposits it in the bloodstream; these fluids are then either redistributed in the body or removed through the urinary system.

Symptoms of a Ruptured Spleen

While there are several illnesses that can affect the spleen, the most common issue is splenomegaly, the term for an enlarged spleen. There are many possible causes of an enlarged spleen, including infection and some types of blood cancer, but one of the biggest concerns while the spleen is enlarged is the increased risk of a splenic rupture. When this happens, it means the surface of the spleen has broken and internal bleeding can leak into the abdominal cavity. If left untreated, a ruptured spleen can lead to shock and death. Below are some of the common symptoms associated with a rupture of the spleen:

  • Abdominal pain: The most prominent symptom of a rupture is usually abdominal pain on the left side that is described as sharp or stabbing. Though typically experienced in the upper abdomen, the pain can also radiate to the left shoulder (Kehr’s sign).
  • Swelling: In addition to abdominal and left shoulder pain, the area may become swollen or tender to the touch due to blood and fluid accumulation.
  • Lightheadedness: A ruptured spleen can lead to internal bleeding, which in turn can cause a drop in blood pressure and resulting lightheadedness, dizziness, or confusion.
  • Low blood pressure: Since the spleen is partly responsible for regulating bodily fluid levels, a rupture can reduce blood pressure throughout the body. This can also have a negative impact on heart rate.
  • Blurred vision: When blood pressure is low due to blood loss, it can cause blurred vision.

It’s worth noting that it is also possible to experience a spontaneous splenic rupture without any specific spleen injury. In these rare cases, it is usually an underlying condition that weakens the spleen or the blood vessels within it. Examples of problems that can cause this include infections, blood disorders, liver disease, or some autoimmune diseases. As rare as it is, however, it represents a medical emergency that requires rapid treatment.

What Can Cause a Ruptured Spleen?

Even if the rupture isn’t spontaneous, though, it remains a life-threatening medical condition that must be taken seriously. The most common cause of a rupture is a splenic injury due to a blunt abdominal trauma. Abdominal injuries can happen almost anywhere, but they tend to happen in situations like contact sports or in a car accident. Such a trauma is more likely under the following conditions:

  • Enlarged spleen: As noted above, perhaps the biggest factor in the chances of a splenic rupture is splenomegaly. The reason for this is that excess fluid increases the internal pressure and makes the surface more fragile; an enlarged spleen means that it takes less force than it normally would to rupture.
  • Blood disorders: Hematological conditions like sickle cell anemia and thalassemia can result in abnormal red blood cells that can cause dangerous congestion in the spleen.
  • Inflammatory conditions: Certain inflammatory conditions like chronic pancreatitis can result in inflammation of the spleen and make it more susceptible to bursting.
  • Medications: Some medications, especially anticoagulants (blood thinners), can increase the risk of bleeding and may contribute to spleen rupture in some individuals.
  • Mono: In rare cases, infectious mononucleosis caused by the Epstein-Barr virus can also lead to an enlarged spleen and a higher risk of rupture.

    Diagnosis and Treatment of a Ruptured Spleen

    Apart from the rare case of a spontaneous rupture, most of the time a rupture is related to a traumatic injury; for this reason diagnosis and treatment are usually wrapped up in the emergency response. In cases where it’s not immediately obvious a rupture has occurred yet symptoms are present, doctors may need to perform a physical exam and/or use imaging tests like a CT scan (computed tomography). A blood test may also be used to determine red blood cell count or hemoglobin levels. If it has been determined that a rupture has occurred, there are several treatment methods that can be used:

    • Observation: It is possible to have a minor rupture, and in that case bed rest and observation may be all that is required. This would also apply to scenarios where an underlying cause of enlargement was determined.
    • Blood transfusion: If there is significant blood loss, patients may receive blood transfusions to replace lost blood and improve hemodynamic stability. This is particularly important if the patient becomes anemic or experiences a drop in blood pressure.
    • Embolization: In some cases, a catheter can be used to block the blood vessels that are bleeding. This can reduce pressure and counter enlargement of the spleen.
    • Surgery: In the most severe cases, surgery may be necessary. This can include surgically repairing the rupture if the damage is relatively minor; if not, spleen removal surgery (splenectomy) may be the only remaining option.

    Contact Cary Gastro

    Traumatic injuries are by far the most common cause of a ruptured spleen, but there are a variety of other factors that can make a rupture more likely. If you have been experiencing any of the symptoms noted above after recently being injured, you should seek medical attention as soon as possible. However, some of the symptoms that relate to swelling and abdominal pain may be mistaken for a gastrointestinal problem; in that case, you’d be better off contacting our experienced and professional staff at Cary Gastroenterology. Please contact us today to request an appointment.