Makindo Medical Notes

⚠️ Splenic rupture is a life-threatening emergency. Risk is highest in splenomegaly (e.g. infectious mononucleosis, haematological malignancy, liver disease, infiltrative disorders).

📌 About

• 🩸 The spleen is the most commonly injured solid organ in blunt abdominal trauma.
• 🚗 Common causes: road traffic collisions, sports injuries, bicycle handlebar accidents, falls, domestic violence.
• ⏱️ Early recognition is vital to prevent haemorrhagic shock.

🧬 Aetiology

• ⚡ Highly vascular organ (75–150 g) filtering 10–15% of blood volume per minute.
• 🧪 Acts as a reservoir for RBCs and platelets → increased bleeding risk if ruptured.
• 🌍 Spontaneous rupture can occur with splenomegaly (EBV, malaria, haematological malignancies).

👩‍⚕️ Clinical Presentation

• 🚨 Signs of shock: tachycardia, hypotension, pallor, cold peripheries.
• 🤕 Left upper quadrant (LUQ) pain and tenderness with guarding.
• 💡 Kehr’s sign: referred pain to left shoulder from diaphragmatic irritation.
• ⏳ Symptoms may be delayed → serial assessment is essential.
• 🔎 Always assess for associated injuries (rib fractures, liver injuries, diaphragm rupture).

🔍 Investigations

• 🧪 Bloods: FBC, U&E, LFTs, clotting, crossmatch for transfusion.
• 🫁 Chest X-ray: rib fractures, diaphragmatic injury, haemothorax.
• 🖥️ FAST ultrasound: rapid detection of intra-abdominal free fluid.
• 📸 CT abdomen (gold standard): defines laceration, haematoma, active bleeding.

🛠️ Management

• 🧑‍⚕️ ABCDE approach: airway, breathing, circulation; secure large-bore IV access; resuscitate with fluids/blood.
• 💊 Reverse anticoagulation if on warfarin/DOACs or correct coagulopathy.
• 👀 Conservative: stable patients with minor tears → observation or splenic artery embolisation.
• 🔪 Surgery: unstable or uncontrolled bleeding → splenectomy (definitive) or splenic repair (splenorrhaphy).
• 🛡️ Post-splenectomy: vaccinate (pneumococcal, Hib, meningococcal), consider prophylactic antibiotics, educate patient about lifelong risk of overwhelming sepsis (OPSI).