Materiały źródłowe

• #1 Splenic Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525951/

  The spleen is the visceral organ most frequently injured in blunt abdominal trauma. Trauma is also the most common cause of a ruptured spleen. […] Splenic rupture can be divided into two major categories: traumatic and non-traumatic rupture. The most prevalent major mechanism in traumatic injury (50% to 75%) is the result of motor vehicle injury. Direct abdominal blows and falls are the remaining major causes of traumatic rupture. Additionally, traumatic rupture can present immediately after an injury or may present in a delayed fashion. Non-traumatic splenic rupture is very uncommon, though can be related to underlying pathologic conditions or may be idiopathic. […] Given that the spleen is a highly vascularized organ, significant blood loss can occur from either the parenchyma or the vascular supply to the spleen.

• #2 Splenic Rupture: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/432823-overview

  Although protected under the bony ribcage, the spleen remains the most commonly affected organ in blunt injury to the abdomen in all age groups. […] The spleen, weighing 75-150 g, is a highly vascular organ that filters an estimated 10-15% of total blood volume every minute. […] Because of the immunologic function of the spleen, interest over the last century has turned to salvage of the spleen rather than splenectomy. […] A thorough knowledge of splenic function, anatomy, and pathophysiology is necessary to continue the progress of the last decade and to decrease the mortality rate from this common injury in the United States and worldwide. […] Though normally protected by its anatomic position, preexisting illness or disease can markedly increase the risks and severity of splenic injury. […] Severe acute respiratory syndrome coronavirus 2 can target the spleen, and cases of atraumatic splenic rupture have been reported in patients with coronavirus disease 2019 (COVID-19).

• #3 Ruptured Spleen: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17953-ruptured-spleen

  A ruptured spleen is a medical emergency. It can cause life-threatening internal bleeding. Your spleen bleeds easily and is the most easily injured of all your abdominal organs. […] A ruptured spleen can cause life-threatening internal bleeding. […] 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, its 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. […] Traumatic injuries are the most common causes of splenic rupture, especially car accidents, which cause 50% to 75%. […] 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.

• #4 What is a Ruptured Spleen? Causes, Symptoms, & Treatment – BuzzRx

  https://www.buzzrx.com/blog/what-is-a-ruptured-spleen-causes-symptoms-and-treatment

  The spleen is an abdominal organ. It bleeds easily and is one of the most easily injured organs during blunt trauma. In fact, experts estimate that 4 out of 10 blunt abdominal injuries involve the spleen. A ruptured (torn) spleen from a traumatic injury can cause life-threatening internal bleeding into the abdominal cavity. A ruptured spleen is, therefore, almost always a medical emergency in the context of the polytraumatized patient. […] The most common cause of a ruptured spleen is blunt abdominal trauma, i.e., a forceful blow to the left upper abdomen or left lower chest. This can occur during contact sports, car crashes, and fistfights, for example. A splenic rupture can occur soon after a splenic injury. However, there can also be a delayed rupture and life-threatening bleeding several weeks later.

• #5 Ruptured spleen: Symptoms, treatment, and causes

  https://www.medicalnewstoday.com/articles/192110

  The most common cause of splenic rupture is blunt trauma to the abdomen. […] The spleen is the abdominal organ that is most at risk during blunt trauma injury. […] A tough, elastic outer layer containing muscle fibers covers the spleen. Blunt injury to the spleen can cause this layer to rupture. […] The main complication of a ruptured spleen is bleeding and the problems that can come from it, such as cysts and blood clots. […] Delayed bleeding and spleen death may also result from a ruptured spleen. […] The grading of a ruptured spleen helps doctors determine whether surgical or non-operative management is indicated for treatment.

• #6 Management of splenic injury in the adult trauma patient – UpToDate

  https://www.uptodate.com/contents/management-of-splenic-injury-in-the-adult-trauma-patient

  The spleen is one of the commonly injured intra-abdominal organs. The diagnosis and prompt management of potentially life-threatening hemorrhage is the primary goal. The preservation of functional splenic tissue is secondary and in selected patients can be accomplished using nonoperative management or operative salvage techniques. Any attempt to salvage the spleen is abandoned in the face of ongoing hemorrhage or other life-threatening injuries. Emergency and urgent splenectomy remains a life-saving measure for many patients. […] Splenic injury most commonly occurs following blunt trauma due to motor vehicle collisions (driver, passenger, or pedestrian). However, blunt splenic injury can also result from falls, sports-related activities, or assaults. Penetrating splenic trauma is less common compared with blunt injury and is typically due to assault, but inadvertent impalement may also occur. Assault with a knife compared with gunshot or shotgun wounds is less likely to result in penetrating injury due to the spleen’s protected location. Nevertheless, deep inspiration can displace the spleen to a more subcostal position, making it more vulnerable. Splenomegaly can also increase the risk of traumatic injury and rupture.

• #7 Splenic Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525951/

  The spleen is the visceral organ most frequently injured in blunt abdominal trauma. Trauma is also the most common cause of a ruptured spleen. […] Splenic rupture can be divided into two major categories: traumatic and non-traumatic rupture. The most prevalent major mechanism in traumatic injury (50% to 75%) is the result of motor vehicle injury. Direct abdominal blows and falls are the remaining major causes of traumatic rupture. Additionally, traumatic rupture can present immediately after an injury or may present in a delayed fashion. Non-traumatic splenic rupture is very uncommon, though can be related to underlying pathologic conditions or may be idiopathic. […] Given that the spleen is a highly vascularized organ, significant blood loss can occur from either the parenchyma or the vascular supply to the spleen.

• #8 Splenic Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525951/

  Evaluation for splenic injury is therefore warranted if left lower rib fractures are identified. Up to 20% of adults with left lower rib fractures may have a subsequent splenic injury. […] A splenic injury may not always be clinically apparent, and spontaneous splenic rupture or pathologic splenic rupture can occur after negligible trauma or insignificant events. […] Treatment is dependent on the severity and etiology of rupture, as well as the hemodynamic stability of the patient. Non-operative treatment is attempted in 60% to 90% of patients with blunt traumatic splenic injuries out of a desire to preserve splenic function. […] Exploratory laparotomy is, however, indicated if continuing hemodynamic instability or if the patient has required more than 4 units of blood during a 48-hour period.

• #9

  https://journals.lww.com/md-journal/fulltext/2019/10040/traumatic_spleen_rupture_diagnosed_during.40.aspx

  Spleen is typically injured in blunt abdominal trauma. Spleen injuries make 42% of all blunt abdominal injuries. […] Spleen can rupture in 2 ways depending on its capsule injury. In the process of trauma, transcapsular spleen rupture may happen. In such case, spleen capsule and parenchyma rupture simultaneously and blood effuses into peritoneal cavity. It usually leads to acute blood loss and immediate death. Another possible way of spleen rupture is subcapsular rupture. It involves an initial formation of subcapsular hematoma, which enlarges several hours or days increasing the subcapsular pressure and finally induces capsular rupture. Due to its mechanism, subcapsular rupture is also called a two-stage rupture. […] A pathological rupture is also possible, for instance, in splenomegalic patients. The common reasons of spleen enlargement: malaria, EBV infection, liver diseases, blood cancer (lymphoma, leukemia), angiosarcoma, and amyloidosis. In general, pathological rupture is rare; it happens in 0.1% to 0.5% of cases. There are 3 possible mechanisms of this rupture: spleen capsule straining from within in splenomegalic patients, outside pressing of the capsule while coughing, vomiting, defecating (due to increased intraabdominal pressure), occlusion of the feeding vessel with consequent spleen necrosis and blood issues.

• #10 Ruptured spleen (ruptured spleen) – USZ

  https://www.usz.ch/en/disease/ruptured-spleen/

  A splenic rupture is a tear in the capsule or tissue of the spleen. A ruptured spleen is always an emergency in which doctors must act quickly. This is because bleeding may occur in the abdomen, which can be life-threatening. […] In most cases, the cause of splenic rupture is blunt abdominal trauma. Blunt force acts on the abdominal cavity and damages the spleen, for example in a car or sports accident. Sometimes the splenic rupture occurs spontaneously without the involvement of mechanical forces. Examples include infections, inflammations, tumors or blood diseases. […] There are two different forms of splenic rupture: Single rupture of the spleen: Both the capsule and the tissue rupture and symptoms such as pain in the upper abdomen and circulatory problems set in immediately. […] Two-stage rupture of the spleen: Initially only the tissue of the spleen ruptures and only a few hours, days or weeks later does the capsule also rupture. Initially there are no symptoms and the onset of symptoms is delayed.

• #11 Splenic Injury – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/abdominal-trauma/splenic-injury

  The main immediate consequence of a splenic injury is hemorrhage into the peritoneal cavity. The amount of hemorrhage ranges from small to massive, depending on the nature and degree of injury. Many small lacerations, particularly in children, cease bleeding spontaneously. Larger injuries hemorrhage extensively, often causing hemorrhagic shock. A splenic hematoma sometimes ruptures, usually in the first few days, although rupture can occur from hours to even months after injury. […] The main complications are immediate bleeding and delayed hematoma rupture.

• #12 Spontaneous splenic rupture | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/spontaneous-splenic-rupture?lang=us

  Spontaneous splenic rupture (SSR) (also known as atraumatic splenic rupture) is rare, especially when compared to traumatic splenic rupture. […] The pathogenesis of atraumatic splenic rupture is not well understood. Splenomegaly is present in almost all patients (~95%), although the rupture of normal spleens (both in size and underlying histology) has been reported.

• #13 Spontaneous Rupture of the Spleen: A Case Report and Review of the Literature

  https://www.ej-med.org/index.php/ejmed/article/view/2147

  Non-traumatic ruptures of the spleen are rare, difficult to diagnose and potentially fatal. […] Many theories have been proposed in the pathophysiology of spontaneous splenic rupture. We can mainly retain increased intrasplenic tension due to congestion, vascular anomalies, enzymatic digestion of the splenic capsule or minimal trauma. […] Spleen rupture is favored by a splenic infiltrate. It may be aggravated by antiplatelet agents or anticoagulants but may occur spontaneously or after a minor trauma. The risk of complete splenic rupture with hemoperitoneum and shock, which can occur secondarily, has long justified splenectomy. […] The diagnosis of splenic rupture is challenging. It may be revealed by a left upper quadrant pain and hemodynamic instability. […] Radiology is the key to suggesting the diagnosis; ultrasound is the first imaging to demand its low specificity. CT scan is the key test to make the diagnosis and grade the splenic injury.

• #14

  https://journals.lww.com/sjga/fulltext/2007/13040/spontaneous_rupture_of_the_malarial_spleen.2.aspx

  Spontaneous rupture of the spleen is a well-described occurrence in many diseases, being most commonly found in malaria. […] The exact mechanism of spleen rupture is not known. However, three mechanisms have been implicated in the process. The first of these mechanisms is an increase in intrasplenic tension that is due to cellular hyperplasia and engorgement. Second, the spleen may be compressed by abdominal musculature during physiological activities such as sneezing, coughing, defecating and sitting up or turning in bed. Finally, vascular occlusion due to reticuloendothelial hyperplasia may be involved which ultimately results in thrombosis and infarction. This leads to interstitial and subcapsular hemorrhage and stripping of the capsule, which further results in the distended capsule finally giving way.

• #15

  https://journals.lww.com/sjga/fulltext/2007/13040/spontaneous_rupture_of_the_malarial_spleen.2.aspx

  Spontaneous rupture of the spleen is a well-described occurrence in many diseases, being most commonly found in malaria. […] The exact mechanism of spleen rupture is not known. However, three mechanisms have been implicated in the process. The first of these mechanisms is an increase in intrasplenic tension that is due to cellular hyperplasia and engorgement. Second, the spleen may be compressed by abdominal musculature during physiological activities such as sneezing, coughing, defecating and sitting up or turning in bed. Finally, vascular occlusion due to reticuloendothelial hyperplasia may be involved which ultimately results in thrombosis and infarction. This leads to interstitial and subcapsular hemorrhage and stripping of the capsule, which further results in the distended capsule finally giving way.

• #16 Spontaneous Splenic Rupture Secondary to Infectious Mononucleosis

  https://www.mdpi.com/2075-4418/14/14/1536

  Spontaneous splenic rupture (SSR) is a relatively rare but potentially lethal complication of infectious mononucleosis (IM). While SSR is extremely rare in patients with proven IM, it is the most lethal complication of the infection (9% mortality rate) and can present completely asymptomatically or with abdominal pain and hemodynamic instability. […] This case demonstrates that, even if SSR in patients with IM is extremely rare, it should always be considered in a patient with a relevant clinical presentation. […] An SSR complicating IM is a rare complication, occurring in 0.1–0.5 percent of patients with proven IM. During the EBV infection, the mononuclear cells collect within the lymphoid tissue, causing the enlargement of the spleen. In about 50% of patients with splenomegaly, as the spleen enlarges, the splenic capsule thins and the spleen is vulnerable to laceration or rupture.

• #17 Spontaneous splenic rupture | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/spontaneous-splenic-rupture?lang=us

  Spontaneous splenic rupture (SSR) (also known as atraumatic splenic rupture) is rare, especially when compared to traumatic splenic rupture. […] The pathogenesis of atraumatic splenic rupture is not well understood. Splenomegaly is present in almost all patients (~95%), although the rupture of normal spleens (both in size and underlying histology) has been reported.

• #18 Splenic Pathology in Traumatic Rupture of the Spleen: A Five Year Study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3273937/

  Rupture of the spleen can occur spontaneously or due to trauma. The incidence of traumatic rupture of the spleen increases due to rise in automobile accidents. Some studies have considered spleens affected by trauma to be normal and have used such spleens as control specimens in their studies. On the other hand, many studies have shown that there is an increased amount of white pulp in spleens from patients with traumatic injury. This has led to the speculation that in many cases of traumatic rupture, there could be a predisposing factor. […] In this study, all 17 cases resulted from RTA in which the victims were either pedestrians or occupants of vehicles. The adult male in his second decade of life showed the greatest predisposition to this type of injury. Increased weight of the spleen was found to be an independent factor associated with rupture of the spleen.

• #19 Spontaneous Splenic Rupture Following Bouts of Coughing: A Rare Case Report and Literature Review | Biswas | Journal of Current Surgery

  https://www.currentsurgery.org/index.php/jcs/article/view/308/279

  For non-traumatic rupture of the spleen, the most common etiologies are infections, neoplasia and connective tissue disease. The common causes of infiltrative or inflammatory pathology are malaria, mononucleosis, CMV, typhoid fever, endocarditis with splenic embolism, pneumonia, viral hepatitis, etc. The common hematological causes are non-Hodgkin and Hodgkins lymphoma, ALL, CML, acute myelogenous leukemia (AML), hairy cell leukemia and histiocytosis. […] Spontaneous splenic ruptures are also caused by anticoagulation, thrombolytics, recombinant granulocyte-colony stimulating factor, and anti-platelet agents. […] The clinical picture of traumatic rupture and non-traumatic rupture of the spleen are identical. The spleen is normal on gross and microscopic examination with rupture and bleeding. The common clinical presentation is hypovolemic shock along with signs of peritonitis.

• #20

  https://journals.lww.com/sjga/fulltext/2007/13040/spontaneous_rupture_of_the_malarial_spleen.2.aspx

  Despite the often massive splenic size in chronic malaria, spontaneous rupture of the spleen occurs almost always exclusively during acute infection and usually during the primary attack. This occurrence is probably due to rapid hyperplasia, stretching of splenic parenchyma and the capsule, a high frequency of small infarctions, haemorrhage, tears, a lack of extensive connective tissue and fibrosis (as found in chronic malarial spleens), an increased risk of minor stress to the spleen (e.g., vomiting, rigors) and a lack of prior immunity.

• #21 Spontaneous splenic rupture secondary to lymphoma: Two case reports | 2020, Volume 6 – Issue 2 | Demiroglu Science University Florence Nightingale Journal of Medicine

  https://www.journalmeddbu.com/full-text/200

  Spontaneous splenic rupture (SSR) is a dramatic abdominal emergency that requires immediate diagnosis and prompt surgical intervention to ensure survival. The most common causes of SSR are infections, hematologic malignancies, and cystic lesions of the spleen. Although the spleen is often involved in hematological malignancies, splenic rupture is a rare condition. […] Diseases that commonly cause SSR are often hemato-oncological diseases. In addition, various clinical manifestations such as infectious diseases (infectious mononucleosis and malaria), congenital splenic lesions, acute and chronic pancreatitis, hamartoma, hemangioma, cyst, autoimmune diseases, hemolytic anemia, pregnancy, amyloidosis, and portal hypertension may also cause SSR. […] The prevalence of SSR due to hematological diseases has been reported as 1% in the literature. Primer splenic lymphoma is the first order of hematological causes of spontaneous splenic rupture.

• #22 Splenic Rupture Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/432823-workup

  Histologic findings may help to explain why a minor trauma resulted in a major splenic injury. Splenic rupture may follow after a seemingly minor transfer of kinetic energy because of organ expansion with capsular thinning or an abnormal internal architecture with reduced elasticity to the parenchyma. Such events may happen with splenomegaly due to hematologic abnormalities (eg, hereditary spherocytosis), infectious diseases (eg, malaria), and liver disease (eg, portal and splenic hypertension). […] Splenic injury is graded using the standards published by the Organ Injury Scaling Committee of the AAST. Categories range from grade I (minor) to grade V (major) and correlate to the need for laparotomy. These grades are used in conjunction with nonoperative assessment (eg, CT scanning, angiography), operative intervention by laparotomy, or postmortem by autopsy. Some studies comparing CT staging with operative staging indicate that CT scanning overestimates the injury by as much as 10%. However, CT scan findings correlate well with the need for operative intervention.

• #23 ClinMed International Library | Spontaneous Spleen Rupture: An Unusual Involvement of the Spleen in Systemic Lupus Erythematosus | Clinical Medical Reviews and Case Reports |

  http://clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-3-096.php?jid=cmrcr

  The involvement of the reticuloendothelial system in systemic lupus erythematosus (SLE) concomitant to the disease activity is highly variable, and well-recognised but spontaneous splenic rupture is an unusual occurrence. […] The spontaneous rupture of the spleen, which occurs suddenly or insidiously, was first described by Aktinson, and is a rare complication of infectious, haematological, neoplasic and rheumatic disorders, like SLE. […] Spontaneous non-traumatic rupture is extremely rare and has been associated as an unusual event in patients with SLE and so far, only six cases have been reported in the literature. […] The immune system functions are closely linked to the spleen. Involvement of the reticuloendothelial system in SLE is a well-recognized and can present with lymphadenopathy and splenomegaly, abscesses, abnormal spleen function, histological abnormalities, capsulitis, infarction, and spontaneous rupture.

• #24 Splenic Pathology in Traumatic Rupture of the Spleen: A Five Year Study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3273937/

  Most of the spleens removed for trauma showed capsular laceration and hemorrhage. Microscopic findings included neutrophilic infiltrates at the lacerated site and in some cases, subcapsular infiltrates were also observed. Congestion and intraparenchymal hemorrhage were seen in most of the cases. Some studies found that the spleens removed following trauma to be normal. But a few other studies have shown that ruptured spleens exhibit follicular hyperplasia suggesting the possibility of immune stimulation as a predisposing factor for splenic rupture following trauma. […] This could have facilitated splenic rupture as amyloidosis has been associated with spontaneous splenic rupture especially considering the fact that the spleen was not enlarged. Multiple small discrete granulomas with calcific material were noted in a 13 year old female. Pathological findings in similar previous studies included lipogranulomas, extramedullary hematopoiesis, subintimal hyaline deposits and infarction. However, no such lesions were encountered in this study.

• #25 Splenic Rupture Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/432823-workup

  Histologic findings may help to explain why a minor trauma resulted in a major splenic injury. Splenic rupture may follow after a seemingly minor transfer of kinetic energy because of organ expansion with capsular thinning or an abnormal internal architecture with reduced elasticity to the parenchyma. Such events may happen with splenomegaly due to hematologic abnormalities (eg, hereditary spherocytosis), infectious diseases (eg, malaria), and liver disease (eg, portal and splenic hypertension). […] Splenic injury is graded using the standards published by the Organ Injury Scaling Committee of the AAST. Categories range from grade I (minor) to grade V (major) and correlate to the need for laparotomy. These grades are used in conjunction with nonoperative assessment (eg, CT scanning, angiography), operative intervention by laparotomy, or postmortem by autopsy. Some studies comparing CT staging with operative staging indicate that CT scanning overestimates the injury by as much as 10%. However, CT scan findings correlate well with the need for operative intervention.

• #26 Spontaneous Splenic Rupture Secondary to Infectious Mononucleosis

  https://www.mdpi.com/2075-4418/14/14/1536

  Spontaneous splenic rupture (SSR) is a relatively rare but potentially lethal complication of infectious mononucleosis (IM). While SSR is extremely rare in patients with proven IM, it is the most lethal complication of the infection (9% mortality rate) and can present completely asymptomatically or with abdominal pain and hemodynamic instability. […] This case demonstrates that, even if SSR in patients with IM is extremely rare, it should always be considered in a patient with a relevant clinical presentation. […] An SSR complicating IM is a rare complication, occurring in 0.1–0.5 percent of patients with proven IM. During the EBV infection, the mononuclear cells collect within the lymphoid tissue, causing the enlargement of the spleen. In about 50% of patients with splenomegaly, as the spleen enlarges, the splenic capsule thins and the spleen is vulnerable to laceration or rupture.

• #27 Splenic Pathology in Traumatic Rupture of the Spleen: A Five Year Study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3273937/

  Most of the spleens removed for trauma showed capsular laceration and hemorrhage. Microscopic findings included neutrophilic infiltrates at the lacerated site and in some cases, subcapsular infiltrates were also observed. Congestion and intraparenchymal hemorrhage were seen in most of the cases. Some studies found that the spleens removed following trauma to be normal. But a few other studies have shown that ruptured spleens exhibit follicular hyperplasia suggesting the possibility of immune stimulation as a predisposing factor for splenic rupture following trauma. […] This could have facilitated splenic rupture as amyloidosis has been associated with spontaneous splenic rupture especially considering the fact that the spleen was not enlarged. Multiple small discrete granulomas with calcific material were noted in a 13 year old female. Pathological findings in similar previous studies included lipogranulomas, extramedullary hematopoiesis, subintimal hyaline deposits and infarction. However, no such lesions were encountered in this study.

• #28 Spontaneous Splenic Rupture Following Bouts of Coughing: A Rare Case Report and Literature Review | Biswas | Journal of Current Surgery

  https://www.currentsurgery.org/index.php/jcs/article/view/308/279

  For non-traumatic rupture of the spleen, the most common etiologies are infections, neoplasia and connective tissue disease. The common causes of infiltrative or inflammatory pathology are malaria, mononucleosis, CMV, typhoid fever, endocarditis with splenic embolism, pneumonia, viral hepatitis, etc. The common hematological causes are non-Hodgkin and Hodgkins lymphoma, ALL, CML, acute myelogenous leukemia (AML), hairy cell leukemia and histiocytosis. […] Spontaneous splenic ruptures are also caused by anticoagulation, thrombolytics, recombinant granulocyte-colony stimulating factor, and anti-platelet agents. […] The clinical picture of traumatic rupture and non-traumatic rupture of the spleen are identical. The spleen is normal on gross and microscopic examination with rupture and bleeding. The common clinical presentation is hypovolemic shock along with signs of peritonitis.

• #29 Spontaneous Splenic Rupture Following Bouts of Coughing: A Rare Case Report and Literature Review | Biswas | Journal of Current Surgery

  https://www.currentsurgery.org/index.php/jcs/article/view/308/279

  For non-traumatic rupture of the spleen, the most common etiologies are infections, neoplasia and connective tissue disease. The common causes of infiltrative or inflammatory pathology are malaria, mononucleosis, CMV, typhoid fever, endocarditis with splenic embolism, pneumonia, viral hepatitis, etc. The common hematological causes are non-Hodgkin and Hodgkins lymphoma, ALL, CML, acute myelogenous leukemia (AML), hairy cell leukemia and histiocytosis. […] Spontaneous splenic ruptures are also caused by anticoagulation, thrombolytics, recombinant granulocyte-colony stimulating factor, and anti-platelet agents. […] The clinical picture of traumatic rupture and non-traumatic rupture of the spleen are identical. The spleen is normal on gross and microscopic examination with rupture and bleeding. The common clinical presentation is hypovolemic shock along with signs of peritonitis.

• #30 Splenic Rupture During Pregnancy: A Misdiagnosed, Rare Obstetrical Emergency – International Journal of Recent Surgical and Medical Sciences

  https://ijrsms.com/splenic-rupture-during-pregnancy-a-misdiagnosed-rare-obstetrical-emergency/

  Splenic rupture in pregnancy is a rare entity, and the exact ethology is not very clear. Splenic rupture during pregnancy can be due to trauma or spontaneous due to other non-traumatic causes like hemophilias, leukaemia, kalazaar, splenic artery aneurysm, etc. […] A spontaneous rupture of the spleen is a rare, life-threatening condition that is usually misdiagnosed. It is often observed after trauma and in pre-existing pathology of the spleen, like splenic artery aneurysm or thalassemia, or infections such as malaria, typhoid, or infectious mononucleosis. […] Splenic rupture in pregnancy is attributed to physiological factors like hypervolemic state and splenic enlargement and mechanical factors like decreased peritoneal cavity volume due to an enlarged uterus and muscular contractions during pregnancy. The risk of splenic rupture is further increased because of compression by abdominal musculature when there is an increase in intra-abdominal pressure following minimal strain like coughing or sneezing and observed mostly in the third trimester or puerperium.

• #31 Splenic Rupture During Pregnancy: A Misdiagnosed, Rare Obstetrical Emergency – International Journal of Recent Surgical and Medical Sciences

  https://ijrsms.com/splenic-rupture-during-pregnancy-a-misdiagnosed-rare-obstetrical-emergency/

  The etiology of spontaneous rupture of a normal spleen in pregnancy is not completely understood. It has been suggested that splenic enlargement, increased blood volume, and diminished peritoneum cavity volume due to an enlarged pregnant uterus could be implicated in the pathogenesis of splenic rupture. […] Estrogen and progesterone cause structural changes to the spleen that may increase the risk of splenic rupture during pregnancy, even after minor trauma or without any underlying cause. […] The most common symptom of atraumatic splenic rupture is left upper quadrant abdominal pain, which is sharp. […] The treatment of splenic rupture involves primary surgical treatment like total splenectomy, non-surgical treatment like splenic arterial embolization, or conservative management. […] Pregnancy with massive splenomegaly can also lead to lacerations over the spleen during labor, as uterine contraction can cause minor injury to the spleen.

• #32 Post Colonoscopy Splenic Injuries: Case Series and Recommendations | Malik | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/1498/907

  One proposed mechanism referred to traction on the splenocolic ligament (or previously formed splenocolic adhesions) leading to an avulsion related injury of the spleen. Another mechanism could be direct contact splenic trauma due to colonoscopic manipulation within the bowel. […] It is suspected that these adhesions are stretched by the manipulation of the colon. Such can be looping of the colonoscope in the colon, a simple rotational manoeuvre to guide the colonoscope past the splenic and hepatic flexure, followed by gentle straightening of the scope. A forceful straightening may increase the tension on the splenocolic ligament, leading to tearing of blood vessels in the vicinity of inferior polar artery, without necessarily the ligament itself. […] Another important consideration is the past history of trauma in patients due for colonoscopy.

• #33

  https://journals.lww.com/sjga/fulltext/2007/13040/spontaneous_rupture_of_the_malarial_spleen.2.aspx

  Despite the often massive splenic size in chronic malaria, spontaneous rupture of the spleen occurs almost always exclusively during acute infection and usually during the primary attack. This occurrence is probably due to rapid hyperplasia, stretching of splenic parenchyma and the capsule, a high frequency of small infarctions, haemorrhage, tears, a lack of extensive connective tissue and fibrosis (as found in chronic malarial spleens), an increased risk of minor stress to the spleen (e.g., vomiting, rigors) and a lack of prior immunity.

• #34 Splenic Rupture: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/432823-overview

  Although protected under the bony ribcage, the spleen remains the most commonly affected organ in blunt injury to the abdomen in all age groups. […] The spleen, weighing 75-150 g, is a highly vascular organ that filters an estimated 10-15% of total blood volume every minute. […] Because of the immunologic function of the spleen, interest over the last century has turned to salvage of the spleen rather than splenectomy. […] A thorough knowledge of splenic function, anatomy, and pathophysiology is necessary to continue the progress of the last decade and to decrease the mortality rate from this common injury in the United States and worldwide. […] Though normally protected by its anatomic position, preexisting illness or disease can markedly increase the risks and severity of splenic injury. […] Severe acute respiratory syndrome coronavirus 2 can target the spleen, and cases of atraumatic splenic rupture have been reported in patients with coronavirus disease 2019 (COVID-19).

• #35 The presentation of spontaneous splenic rupture in a COVID-19 patient: a case report | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-020-00887-5

  It has been believed that increased intra-abdominal pressure or diaphragmatic contraction during severe coughing, vomiting, and defecation which leads to pressure on the spleen, is the cause of this type of splenic rupture. However, Patel et al. believed that this was primarily the result of a progressive subcapsular hematoma that subsequently ruptured the capsule and caused hemoperitoneum. […] Based on the role of the spleen in immunity and overwhelming post-splenectomy infection (OPSI), there is a tendency to conservative management of splenic rupture in hemodynamically stable patients. […] According to the above-mentioned discussions, can COVID-19 be another infectious cause of spontaneous splenic rupture (SSR)? Examining this issue requires further investigation and waiting for similar reports.

• #36 ABSTRACT

  https://www.ejcrim.com/index.php/EJCRIM/article/download/1891/2345

  Spontaneous splenic rupture is a known, but rare and possibly fatal, complication of different infectious diseases. […] Spontaneous splenic rupture is a rare complication of several tropical diseases, including Salmonella infection. […] Spontaneous splenic rupture is a very rare complication of systemic Salmonella infection. […] In cases of splenic rupture in Salmonella infections, the causative organism is predominately Salmonella Typhi or Paratyphi. […] In our patient, the systemic Salmonella infection probably caused splenomegaly and spontaneous splenic rupture at the time of the acute infection as a result of a soft and swollen spleen. […] Spontaneous splenic rupture is a rare complication of different tropical diseases where fever is an important feature. […] The most important tropical infection associated with splenic rupture is tuberculosis. […] Rupture of the spleen due to infectious causes is most commonly seen in viral infections. […] Spontaneous splenic rupture is a known, but rare and possibly fatal, complication of different tropical infectious diseases.

• #37 Splenic Rupture Following Colonoscopy | ACS

  https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n1/foster-splenic-rupture/

  Splenic rupture is a serious complication of any colonoscopy. […] The mechanism of splenic rupture following endoscopy is not fully understood, but several theories exist. The most common explanation consists of excessive traction from the splenocolic ligament during navigation of the colon with the colonoscope, thereby pulling the splenic capsule off the spleen, causing avulsion and laceration. […] Splenic injuries can be a fatal complication of colonoscopies that, although rare, are likely more common than the literature shows, given the presence of under-reporting. […] The most likely mechanism includes the avulsion of the splenic capsule due to excessive traction on the splenocolic ligament during navigation of the colon.

• #38 Post Colonoscopy Splenic Injuries: Case Series and Recommendations | Malik | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/1498/907

  Splenic injury is an uncommon, but serious complication of colonoscopy. Any cause of excessive spleno-colic adhesions, splenomegaly, or underlying splenic disease would be a predisposing factor for splenic injury during colonoscopy. […] Proposed mechanisms are traction on the spleno-colic ligament leading to splenic capsule avulsion or direct splenic trauma due to colonoscopic manipulation. So-called looping of the colonoscope in the bowel, followed by aggressive straightening can cause strain on the spleno-colic ligament and tearing of blood vessels. […] The most likely mechanism of injury is that of traction on the spleen by way of pre-existing adhesions. This occurs during manipulation of the colon at the time of colonoscopy. Excessive spleno-colic adhesions, splenomegaly and other splenic pathology are therefore regarded as predisposing factors.

• #39 Post Colonoscopy Splenic Injuries: Case Series and Recommendations | Malik | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/1498/907

  One proposed mechanism referred to traction on the splenocolic ligament (or previously formed splenocolic adhesions) leading to an avulsion related injury of the spleen. Another mechanism could be direct contact splenic trauma due to colonoscopic manipulation within the bowel. […] It is suspected that these adhesions are stretched by the manipulation of the colon. Such can be looping of the colonoscope in the colon, a simple rotational manoeuvre to guide the colonoscope past the splenic and hepatic flexure, followed by gentle straightening of the scope. A forceful straightening may increase the tension on the splenocolic ligament, leading to tearing of blood vessels in the vicinity of inferior polar artery, without necessarily the ligament itself. […] Another important consideration is the past history of trauma in patients due for colonoscopy.

• #40 Post Colonoscopy Splenic Injuries: Case Series and Recommendations | Malik | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/1498/907

  Splenic injury is an uncommon, but serious complication of colonoscopy. Any cause of excessive spleno-colic adhesions, splenomegaly, or underlying splenic disease would be a predisposing factor for splenic injury during colonoscopy. […] Proposed mechanisms are traction on the spleno-colic ligament leading to splenic capsule avulsion or direct splenic trauma due to colonoscopic manipulation. So-called looping of the colonoscope in the bowel, followed by aggressive straightening can cause strain on the spleno-colic ligament and tearing of blood vessels. […] The most likely mechanism of injury is that of traction on the spleen by way of pre-existing adhesions. This occurs during manipulation of the colon at the time of colonoscopy. Excessive spleno-colic adhesions, splenomegaly and other splenic pathology are therefore regarded as predisposing factors.

• #41

  https://journals.lww.com/md-journal/fulltext/2019/10040/traumatic_spleen_rupture_diagnosed_during.40.aspx

  Acute spleen rupture prevalently happens during blunt abdominal trauma because of suddenly increased intraabdominal pressure. It suggests that external body injuries may not always be seen. However, traumatized patients usually complain about pain in the left upper part of abdomen, as well as in the region of left shoulder (Kehr’s symptom). Therefore, these clinical symptoms are first to be evaluated suspecting spleen injury. […] Two-stage spleen rupture cases are rarer than the acute, although their lethal outcome is more frequent due to the complicated diagnostics.

• #42 Splenic injuries – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/splenic-injuries/

  Splenic rupture is an injury that compromises the structural integrity of the splenic capsule, parenchyma, or vasculature. […] Acute splenic rupture: injury of the splenic capsule and possibly the splenic parenchymal tissue acute intraabdominal bleeding. […] Delayed splenic rupture: can occur if capsule ruptures days to weeks after subcapsular hematoma formation. […] In delayed splenic rupture, symptoms may take days to weeks to manifest after abdominal trauma. […] Management of atraumatic splenic rupture closely resembles that of traumatic rupture. […] Nonoperative management is appropriate for hemodynamically stable patients with small, contained rupture without radiological signs of active bleeding (e.g., contrast blush). […] Angioembolization may be considered in patients with moderate to severe lesions or vascular injuries identified on CT (e.g., contrast blush, pseudoaneurysms, or AV fistulas).

• #43 A rare mechanism of delayed splenic rupture following the nonoperative management of blunt splenic injury in a child | Surgical Case Reports | Full Text

  https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-018-0477-5

  Nonoperative management (NOM) has been established as the standard treatment for isolated blunt organ injury in hemodynamically stable pediatric patients. […] Although delayed splenic rupture or bleeding is a rare complication in NOM, it is an issue that many pediatric surgeons are greatly concerned about. […] The mechanism of delayed splenic rupture in our case was considered to be the result of a tear in the subcapsular hematoma caused by stretching the splenocolic ligament related to a bowel movement during defecation. […] We believe the mechanism causing the splenic capsule to tear involved stretching the splenocolic ligament, leading to colonic peristalsis during defecation. […] The mechanism of delayed splenic rupture in our case was considered to be the result of a tear in the subcapsular hematoma caused by stretching of the splenocolic ligament.

• #44 A rare mechanism of delayed splenic rupture following the nonoperative management of blunt splenic injury in a child | Surgical Case Reports | Full Text

  https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-018-0477-5

  The patient started complaining about abdominal and shoulder pain suddenly after defecation, which led us to suspect that the bowel movement had caused the splenocolic ligament to stretch at the splenic flexure. […] Given our understanding of the mechanisms involved in delayed splenic rupture, we strongly recommend careful observation of patients after beginning oral intake. […] It is very important to understand that gastrointestinal peristalsis can cause delayed splenic rupture.

• #45 Splenic Pathology in Traumatic Rupture of the Spleen: A Five Year Study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3273937/

  Rupture of the spleen can occur spontaneously or due to trauma. The incidence of traumatic rupture of the spleen increases due to rise in automobile accidents. Some studies have considered spleens affected by trauma to be normal and have used such spleens as control specimens in their studies. On the other hand, many studies have shown that there is an increased amount of white pulp in spleens from patients with traumatic injury. This has led to the speculation that in many cases of traumatic rupture, there could be a predisposing factor. […] In this study, all 17 cases resulted from RTA in which the victims were either pedestrians or occupants of vehicles. The adult male in his second decade of life showed the greatest predisposition to this type of injury. Increased weight of the spleen was found to be an independent factor associated with rupture of the spleen.

• #46 Splenic Pathology in Traumatic Rupture of the Spleen: A Five Year Study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3273937/

  Most of the spleens removed for trauma showed capsular laceration and hemorrhage. Microscopic findings included neutrophilic infiltrates at the lacerated site and in some cases, subcapsular infiltrates were also observed. Congestion and intraparenchymal hemorrhage were seen in most of the cases. Some studies found that the spleens removed following trauma to be normal. But a few other studies have shown that ruptured spleens exhibit follicular hyperplasia suggesting the possibility of immune stimulation as a predisposing factor for splenic rupture following trauma. […] This could have facilitated splenic rupture as amyloidosis has been associated with spontaneous splenic rupture especially considering the fact that the spleen was not enlarged. Multiple small discrete granulomas with calcific material were noted in a 13 year old female. Pathological findings in similar previous studies included lipogranulomas, extramedullary hematopoiesis, subintimal hyaline deposits and infarction. However, no such lesions were encountered in this study.

• #47 Splenic Pathology in Traumatic Rupture of the Spleen: A Five Year Study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3273937/

  Most of the spleens removed for trauma showed capsular laceration and hemorrhage. Microscopic findings included neutrophilic infiltrates at the lacerated site and in some cases, subcapsular infiltrates were also observed. Congestion and intraparenchymal hemorrhage were seen in most of the cases. Some studies found that the spleens removed following trauma to be normal. But a few other studies have shown that ruptured spleens exhibit follicular hyperplasia suggesting the possibility of immune stimulation as a predisposing factor for splenic rupture following trauma. […] This could have facilitated splenic rupture as amyloidosis has been associated with spontaneous splenic rupture especially considering the fact that the spleen was not enlarged. Multiple small discrete granulomas with calcific material were noted in a 13 year old female. Pathological findings in similar previous studies included lipogranulomas, extramedullary hematopoiesis, subintimal hyaline deposits and infarction. However, no such lesions were encountered in this study.

• #48 Full Text: Splenic Pathology in Traumatic Rupture of the Spleen: A Five Year Study

  https://www.omjournal.org/originalarticles/fulltext/200904/ft_splenicpathologytraumaticrupturethespleen.html

  Most of the spleens removed for trauma showed capsular laceration and hemorrhage. Microscopic findings included neutrophilic infiltrates at the lacerated site and in some cases, subcapsular infiltrates were also observed. Congestion and intraparenchymal hemorrhage were seen in most of the cases. Some studies found that the spleens removed following trauma to be normal. But a few other studies have shown that ruptured spleens exhibit follicular hyperplasia suggesting the possibility of immune stimulation as a predisposing factor for splenic rupture following trauma. […] This could have facilitated splenic rupture as amyloidosis has been associated with spontaneous splenic rupture especially considering the fact that the spleen was not enlarged. […] In the five year period of studying splenic pathology in traumatic rupture, 82% of the spleens showed normal histology except for the rupture. 18% of cases showed different pathological findings on histopathology which could have contributed to the rupture.

• #49 Full Text: Splenic Pathology in Traumatic Rupture of the Spleen: A Five Year Study

  https://www.omjournal.org/originalarticles/fulltext/200904/ft_splenicpathologytraumaticrupturethespleen.html

  Most of the spleens removed for trauma showed capsular laceration and hemorrhage. Microscopic findings included neutrophilic infiltrates at the lacerated site and in some cases, subcapsular infiltrates were also observed. Congestion and intraparenchymal hemorrhage were seen in most of the cases. Some studies found that the spleens removed following trauma to be normal. But a few other studies have shown that ruptured spleens exhibit follicular hyperplasia suggesting the possibility of immune stimulation as a predisposing factor for splenic rupture following trauma. […] This could have facilitated splenic rupture as amyloidosis has been associated with spontaneous splenic rupture especially considering the fact that the spleen was not enlarged. […] In the five year period of studying splenic pathology in traumatic rupture, 82% of the spleens showed normal histology except for the rupture. 18% of cases showed different pathological findings on histopathology which could have contributed to the rupture.

• #50 Splenic Rupture Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/432823-workup

  Histologic findings may help to explain why a minor trauma resulted in a major splenic injury. Splenic rupture may follow after a seemingly minor transfer of kinetic energy because of organ expansion with capsular thinning or an abnormal internal architecture with reduced elasticity to the parenchyma. Such events may happen with splenomegaly due to hematologic abnormalities (eg, hereditary spherocytosis), infectious diseases (eg, malaria), and liver disease (eg, portal and splenic hypertension). […] Splenic injury is graded using the standards published by the Organ Injury Scaling Committee of the AAST. Categories range from grade I (minor) to grade V (major) and correlate to the need for laparotomy. These grades are used in conjunction with nonoperative assessment (eg, CT scanning, angiography), operative intervention by laparotomy, or postmortem by autopsy. Some studies comparing CT staging with operative staging indicate that CT scanning overestimates the injury by as much as 10%. However, CT scan findings correlate well with the need for operative intervention.

• #51 Ruptured spleen (ruptured spleen) – USZ

  https://www.usz.ch/en/disease/ruptured-spleen/

  A ruptured spleen can have various consequences, as it has important functions in the body. The spleen helps to purify the blood and is part of the lymphatic system it therefore also has immunological functions. […] A ruptured spleen is always an emergency. Doctors must treat this immediately to avoid life-threatening consequences. […] Depending on the extent of the splenic rupture, five degrees of severity or types can be distinguished: Isolated capsule tear or bruise under the capsule that does not spread. […] Injury to the spleen capsule and spleen tissue the vascular pedicle on the spleen (splenic hilus) or the splenic arteries are not affected. […] The capsule and tissue are injured and there is bleeding from the arteries of the organ. […] Capsule, tissue, splenic hilus and arteries are injured the vascular pedicle is torn off. […] The spleen is ruptured or ruptured in the splenic hilus the blood supply via the vessels is interrupted.

• #52 Splenic Injury – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/abdominal-trauma/splenic-injury

  The main immediate consequence of a splenic injury is hemorrhage into the peritoneal cavity. The amount of hemorrhage ranges from small to massive, depending on the nature and degree of injury. Many small lacerations, particularly in children, cease bleeding spontaneously. Larger injuries hemorrhage extensively, often causing hemorrhagic shock. A splenic hematoma sometimes ruptures, usually in the first few days, although rupture can occur from hours to even months after injury. […] The main complications are immediate bleeding and delayed hematoma rupture.

• #53 Splenic Rupture – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525951/

  The spleen is the visceral organ most frequently injured in blunt abdominal trauma. Trauma is also the most common cause of a ruptured spleen. […] Splenic rupture can be divided into two major categories: traumatic and non-traumatic rupture. The most prevalent major mechanism in traumatic injury (50% to 75%) is the result of motor vehicle injury. Direct abdominal blows and falls are the remaining major causes of traumatic rupture. Additionally, traumatic rupture can present immediately after an injury or may present in a delayed fashion. Non-traumatic splenic rupture is very uncommon, though can be related to underlying pathologic conditions or may be idiopathic. […] Given that the spleen is a highly vascularized organ, significant blood loss can occur from either the parenchyma or the vascular supply to the spleen.

• #54 Ruptured Spleen: Symptoms, Causes, Treatment

  https://www.health.com/ruptured-spleen-8638583

  A ruptured spleen causing severe internal bleeding requires surgical intervention. The type of surgery your healthcare provider performs will depend on the extent of the injury and the severity of the bleeding. Surgical procedures for a ruptured spleen include: Splenic artery embolization, which involves placing permanent or temporary embolization (clotting) materials into the artery that supplies blood to the injured area to stop the bleeding. Splenorrhaphy, which involves repairing the spleen using electrocautery (heat with an electric current) to control bleeding and preserve the organ’s function. Splenectomy, which may be required for splenic ruptures that cause uncontrollable bleeding. […] A ruptured spleen can lead to serious complications and requires prompt treatment. One potential complication is hypovolemic shock, an emergency when the heart is unable to pump enough blood to the body because there has been severe blood loss. Severe internal bleeding from a ruptured spleen can cause rapid blood loss and lead to hypovolemic shock. Hypovolemic shock requires immediate treatment to prevent organ failure or death.

• #55 Ruptured Spleen: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17953-ruptured-spleen

  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. […] 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). […] Severe internal bleeding can cause death within hours if it isnt treated right away. […] A ruptured spleen is an emergency, whether it’s minor or severe. Any internal bleeding can be life-threatening if it isnt managed.

• #56 Ruptured Spleen: Symptoms, Causes, Treatment

  https://www.health.com/ruptured-spleen-8638583

  A ruptured spleen, or splenic rupture, is when the spleen tears open. The spleen is a fist-sized organ located in the upper left abdomen. As part of the lymphatic system, it helps filter blood and eliminate old blood cells. It also produces lymphocytes, which are white blood cells that help the body fight infections. […] A ruptured spleen occurs when the spleen’s capsulethe thick layer of connective tissue surrounding the spleentears and bleeds. This tear causes blood to leak from the spleen into the abdomen. […] Although rare, some illnesses that cause inflammation and enlargement of the spleen (splenomegaly) can weaken the spleen’s capsule and lead to non-traumatic (spontaneous) splenic rupture. Infections like mononucleosis (also known as mono) and hepatitis, as well as connective tissue disorders and certain cancers, can cause an enlarged spleen and increase the risk of splenic rupture from minor trauma.

• #57

  https://step2.medbullets.com/gastrointestinal/121859/splenic-laceration–rupture

  functions of the spleen helps fight infection by producing antibodies and other key immune mediators […] recycles old red blood cells […] stores platelets and white blood cells

• #58

  https://www.aast.org/resources-detail/8764001f-b3b2-425e-89c5-5284d417de1e

  Splenic injuries, whether from penetrating trauma, such as a gunshot or knife wound, or from blunt trauma via motor vehicle crash or fall, are common and can be lethal. […] The spleen has many functions including filtering or removing old poorly functioning red blood cells, catching bacteria, and producing antibodies. […] After removal of the spleen, these functions are lost and the patient could be susceptible to an overwhelming post-splenectomy infections from bacteria such as streptococcus pneumoniae, neisseria meningitidis, and hemophilus influenza. […] If a splenic injury with bleeding is found, removal of the spleen (splenectomy) may be required. […] As a result of understanding the function of the spleen, natural evolution of the splenic injury, improving technology and adjuncts such as angiogram the trauma surgeons are better able to manage blunt spleen injuries nonoperatively more successfully than before. […] Blunt splenic trauma management has evolved significantly over the last few decades and as our understanding of the injury and its evolution improves so does our ability to manage the splenic injury whether it’s nonoperatively or surgically.

• #59 Splenic Rupture – TeachMeSurgery

  https://teachmesurgery.com/hpb/spleen/splenic-rupture/

  Patients who are haemodynamically unstable or with a grade 5 injury (a shattered spleen or major hilar vascular injury) need urgent laparotomy. […] Splenic artery embolisation by interventional radiology is an important alternative management option, where available, potentially negating the need for laparotomy and preserving splenic function. […] The main complications of conservative treatment or embolisation are ongoing bleeding, splenic necrosis, splenic abscess or cyst formation, and thrombocytosis (typically transient). […] The overall mortality rates of patients presenting to hospital with trauma splenic injury are around 10%. […] Asplenic patients are therefore unable to mount a normal immunological response against these organisms and infection can lead to overwhelming sepsis, termed Overwhelming Post-Splenectomy Infection (OPSI).

• #60 Splenic Rupture – TeachMeSurgery

  https://teachmesurgery.com/hpb/spleen/splenic-rupture/

  Patients who are haemodynamically unstable or with a grade 5 injury (a shattered spleen or major hilar vascular injury) need urgent laparotomy. […] Splenic artery embolisation by interventional radiology is an important alternative management option, where available, potentially negating the need for laparotomy and preserving splenic function. […] The main complications of conservative treatment or embolisation are ongoing bleeding, splenic necrosis, splenic abscess or cyst formation, and thrombocytosis (typically transient). […] The overall mortality rates of patients presenting to hospital with trauma splenic injury are around 10%. […] Asplenic patients are therefore unable to mount a normal immunological response against these organisms and infection can lead to overwhelming sepsis, termed Overwhelming Post-Splenectomy Infection (OPSI).

• #61 Splenic Injury – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/abdominal-trauma/splenic-injury

  The main immediate consequence of a splenic injury is hemorrhage into the peritoneal cavity. The amount of hemorrhage ranges from small to massive, depending on the nature and degree of injury. Many small lacerations, particularly in children, cease bleeding spontaneously. Larger injuries hemorrhage extensively, often causing hemorrhagic shock. A splenic hematoma sometimes ruptures, usually in the first few days, although rupture can occur from hours to even months after injury. […] The main complications are immediate bleeding and delayed hematoma rupture.

• #62 Ruptured spleen: Symptoms, treatment, and causes

  https://www.medicalnewstoday.com/articles/192110

  The most common cause of splenic rupture is blunt trauma to the abdomen. […] The spleen is the abdominal organ that is most at risk during blunt trauma injury. […] A tough, elastic outer layer containing muscle fibers covers the spleen. Blunt injury to the spleen can cause this layer to rupture. […] The main complication of a ruptured spleen is bleeding and the problems that can come from it, such as cysts and blood clots. […] Delayed bleeding and spleen death may also result from a ruptured spleen. […] The grading of a ruptured spleen helps doctors determine whether surgical or non-operative management is indicated for treatment.

• #63 Ruptured spleen: Symptoms, treatment, and causes

  https://www.medicalnewstoday.com/articles/192110

  The most common cause of splenic rupture is blunt trauma to the abdomen. […] The spleen is the abdominal organ that is most at risk during blunt trauma injury. […] A tough, elastic outer layer containing muscle fibers covers the spleen. Blunt injury to the spleen can cause this layer to rupture. […] The main complication of a ruptured spleen is bleeding and the problems that can come from it, such as cysts and blood clots. […] Delayed bleeding and spleen death may also result from a ruptured spleen. […] The grading of a ruptured spleen helps doctors determine whether surgical or non-operative management is indicated for treatment.

• #64 Splenic Rupture – TeachMeSurgery

  https://teachmesurgery.com/hpb/spleen/splenic-rupture/

  Patients who are haemodynamically unstable or with a grade 5 injury (a shattered spleen or major hilar vascular injury) need urgent laparotomy. […] Splenic artery embolisation by interventional radiology is an important alternative management option, where available, potentially negating the need for laparotomy and preserving splenic function. […] The main complications of conservative treatment or embolisation are ongoing bleeding, splenic necrosis, splenic abscess or cyst formation, and thrombocytosis (typically transient). […] The overall mortality rates of patients presenting to hospital with trauma splenic injury are around 10%. […] Asplenic patients are therefore unable to mount a normal immunological response against these organisms and infection can lead to overwhelming sepsis, termed Overwhelming Post-Splenectomy Infection (OPSI).

• #65 Splenic injuries – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/splenic-injuries/

  Splenic artery angioembolization improves the success rate of nonoperative management. […] Surgical management: Splenectomy for severe or ongoing bleeding, or if nonoperative management fails. […] Most patients with atraumatic splenic rupture require splenectomy. […] Obstruction or disruption of the splenic artery or its branches splenic infarction. […] Ischemic injury to the spleen that results in tissue necrosis.

• #66 Ruptured Spleen: Causes, Symptoms, Treatment, Recovery

  https://www.healthline.com/health/ruptured-spleen

  In most cases, an enlarged spleen is responsible for a spontaneous rupture or tear. […] Infections and certain medical conditions, such as malaria and lymphoma, can cause blood cells to accumulate in the spleen. […] A ruptured spleen is a medical emergency. […] The spleen is a complex matrix of blood vessels and blood-filled compartments (splenic cords and venous sinuses). In the event of a tear or rupture, internal bleeding is possible. […] If the injury or damage to the spleen is too great, or if doctors are unable to stop the internal bleeding, a splenectomy is often the treatment of choice. […] In 10% to 15% of patients with a blunt spleen injury, surgical spleen removal is necessary. […] A ruptured spleen can also worsen in a matter of a few days or weeks after the initial injury and may rupture again.

• #67 Splenic Rupture – TeachMeSurgery

  https://teachmesurgery.com/hpb/spleen/splenic-rupture/

  Patients who are haemodynamically unstable or with a grade 5 injury (a shattered spleen or major hilar vascular injury) need urgent laparotomy. […] Splenic artery embolisation by interventional radiology is an important alternative management option, where available, potentially negating the need for laparotomy and preserving splenic function. […] The main complications of conservative treatment or embolisation are ongoing bleeding, splenic necrosis, splenic abscess or cyst formation, and thrombocytosis (typically transient). […] The overall mortality rates of patients presenting to hospital with trauma splenic injury are around 10%. […] Asplenic patients are therefore unable to mount a normal immunological response against these organisms and infection can lead to overwhelming sepsis, termed Overwhelming Post-Splenectomy Infection (OPSI).

• #68 What is a Ruptured Spleen? Causes, Symptoms, & Treatment – BuzzRx

  https://www.buzzrx.com/blog/what-is-a-ruptured-spleen-causes-symptoms-and-treatment

  A spleen rupture can cause death. A ruptured spleen occurs when there is a tear or break in the organ’s surface. This is a medical emergency that requires treatment in the hospital, including surgical intervention in some cases. Without emergency treatment, the internal bleeding caused by a ruptured spleen can be fatal. […] You can survive a ruptured spleen provided you get emergency medical care and immediate surgery, if needed. […] Treatment for ruptured spleens depends on the severity of the injuries. Some people with mild to moderate injuries may not require abdominal surgery. The spleen may heal with several days of rest and care in the hospital. […] More severe splenic ruptures often require emergency surgery for spleen repair or spleen removal (this is called a partial or complete splenectomy). It is possible to live without your spleen. However, because the function of the spleen is to prevent infections, removal of the entire spleen or part of the spleen puts you at increased risk of infections. […] Some studies have shown that over 80% of victims die immediately if they do not receive emergency medical or surgical treatment for a ruptured spleen. Death can also occur after hospitalization and treatment of a ruptured spleen due to severe blood loss and other complications.

• #69 Ruptured spleen (ruptured spleen) – USZ

  https://www.usz.ch/en/disease/ruptured-spleen/

  A splenic rupture is a tear in the capsule or tissue of the spleen. A ruptured spleen is always an emergency in which doctors must act quickly. This is because bleeding may occur in the abdomen, which can be life-threatening. […] In most cases, the cause of splenic rupture is blunt abdominal trauma. Blunt force acts on the abdominal cavity and damages the spleen, for example in a car or sports accident. Sometimes the splenic rupture occurs spontaneously without the involvement of mechanical forces. Examples include infections, inflammations, tumors or blood diseases. […] There are two different forms of splenic rupture: Single rupture of the spleen: Both the capsule and the tissue rupture and symptoms such as pain in the upper abdomen and circulatory problems set in immediately. […] Two-stage rupture of the spleen: Initially only the tissue of the spleen ruptures and only a few hours, days or weeks later does the capsule also rupture. Initially there are no symptoms and the onset of symptoms is delayed.

• #70 Splenic Rupture During Pregnancy: A Misdiagnosed, Rare Obstetrical Emergency – International Journal of Recent Surgical and Medical Sciences

  https://ijrsms.com/splenic-rupture-during-pregnancy-a-misdiagnosed-rare-obstetrical-emergency/

  The etiology of spontaneous rupture of a normal spleen in pregnancy is not completely understood. It has been suggested that splenic enlargement, increased blood volume, and diminished peritoneum cavity volume due to an enlarged pregnant uterus could be implicated in the pathogenesis of splenic rupture. […] Estrogen and progesterone cause structural changes to the spleen that may increase the risk of splenic rupture during pregnancy, even after minor trauma or without any underlying cause. […] The most common symptom of atraumatic splenic rupture is left upper quadrant abdominal pain, which is sharp. […] The treatment of splenic rupture involves primary surgical treatment like total splenectomy, non-surgical treatment like splenic arterial embolization, or conservative management. […] Pregnancy with massive splenomegaly can also lead to lacerations over the spleen during labor, as uterine contraction can cause minor injury to the spleen.

• #71 Splenic injuries – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/splenic-injuries/

  Splenic rupture is an injury that compromises the structural integrity of the splenic capsule, parenchyma, or vasculature. […] Acute splenic rupture: injury of the splenic capsule and possibly the splenic parenchymal tissue acute intraabdominal bleeding. […] Delayed splenic rupture: can occur if capsule ruptures days to weeks after subcapsular hematoma formation. […] In delayed splenic rupture, symptoms may take days to weeks to manifest after abdominal trauma. […] Management of atraumatic splenic rupture closely resembles that of traumatic rupture. […] Nonoperative management is appropriate for hemodynamically stable patients with small, contained rupture without radiological signs of active bleeding (e.g., contrast blush). […] Angioembolization may be considered in patients with moderate to severe lesions or vascular injuries identified on CT (e.g., contrast blush, pseudoaneurysms, or AV fistulas).

• #72 Splenic injuries – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/splenic-injuries/

  Splenic rupture is an injury that compromises the structural integrity of the splenic capsule, parenchyma, or vasculature. […] Acute splenic rupture: injury of the splenic capsule and possibly the splenic parenchymal tissue acute intraabdominal bleeding. […] Delayed splenic rupture: can occur if capsule ruptures days to weeks after subcapsular hematoma formation. […] In delayed splenic rupture, symptoms may take days to weeks to manifest after abdominal trauma. […] Management of atraumatic splenic rupture closely resembles that of traumatic rupture. […] Nonoperative management is appropriate for hemodynamically stable patients with small, contained rupture without radiological signs of active bleeding (e.g., contrast blush). […] Angioembolization may be considered in patients with moderate to severe lesions or vascular injuries identified on CT (e.g., contrast blush, pseudoaneurysms, or AV fistulas).

• #73 Splenic injuries – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/splenic-injuries/

  Splenic artery angioembolization improves the success rate of nonoperative management. […] Surgical management: Splenectomy for severe or ongoing bleeding, or if nonoperative management fails. […] Most patients with atraumatic splenic rupture require splenectomy. […] Obstruction or disruption of the splenic artery or its branches splenic infarction. […] Ischemic injury to the spleen that results in tissue necrosis.

• #74 Splenic injuries – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/splenic-injuries/

  Splenic artery angioembolization improves the success rate of nonoperative management. […] Surgical management: Splenectomy for severe or ongoing bleeding, or if nonoperative management fails. […] Most patients with atraumatic splenic rupture require splenectomy. […] Obstruction or disruption of the splenic artery or its branches splenic infarction. […] Ischemic injury to the spleen that results in tissue necrosis.

• #75 Spontaneous Splenic Rupture Secondary to Infectious Mononucleosis

  https://www.mdpi.com/2075-4418/14/14/1536

  Even with all the limitations, our case report showcases an extremely rare but potentially fatal complication of IM. Based on the current National Institute for Health and Care Excellence (NICE) guidance, a patient suffering from IM is advised to avoid contact or collision sports or heavy lifting for the first month of the illness (to reduce the risk of splenic rupture). […] The management of a splenic injury is generally a debate. It depends on the hemodynamic status, resource availability, splenic injury grade, and presence of comorbidities. If possible, splenic preservation is to be preferred, especially in younger patients, to minimize the risk of post-splenectomy infections and septicemia.

• #76 Splenic Injury | Korey Stringer Institute

  https://koreystringer.institute.uconn.edu/splenic-injury/

  It is important that individuals who have been recently diagnosed with IM meet with their doctor for clearance to return to sports. Premature return to sports with an enlarged spleen puts an individual at an increased risk for splenic rupture. […] Once released from hospital, the athlete will need to follow gradual return to play over course of 2 or 3 weeks to allow healing of organ epithelial tissue. The athlete should be monitored very closely by an Athletic Trainer or sports medicine professional to ensure athlete safety and no return of signs or symptoms.

• #77 Post Colonoscopy Splenic Injuries: Case Series and Recommendations | Malik | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/1498/907

  A history of recent trauma should hence be considered a contributing factor to splenic rupture in post-colonoscopy patients and needs to be elicited from the history. […] The presence of Kehrs sign in a hemodynamically unstable patient is a very important indicator of splenic rupture. […] A contrast enhanced CT scan of the abdomen is the test of choice for the evaluation of splenic injury and most frequently reported. […] In the literature reviewed, splenectomy was the most commonly performed (67.9 percent), followed by conservative treatment (28.30 percent). […] Spleen rupture is a rare complication of the colonoscopy. Mild discomfort is common even hours after colonoscopy, but significant abdominal pain and hemodynamic instability following the intervention should warrant a high index of suspicion for splenic injury. […] The presence of hemodynamic compromise however, makes it very specific for splenic injury.

• #78 Splenic Rupture – TeachMeSurgery

  https://teachmesurgery.com/hpb/spleen/splenic-rupture/

  The spleen is an extremely vascular organ and consequently splenic rupture can lead to large intraperitoneal haemorrhage, rapidly leading to fatal haemorrhagic shock. […] The majority of cases of splenic injury are secondary to abdominal trauma – particularly blunt trauma. […] A minority of cases are iatrogenic, or secondary due to underlying splenomegaly from haematological malignancy or infective causes (such as Epstein-Barr virus). In these cases, as the spleen grows, the capsule stretches and thins, becoming more fragile and predisposing to rupture. […] Patients who are haemodynamically unstable with peritonism following trauma have abdominal bleeding until proven otherwise and require immediate laparotomy. […] CT imaging allows for the identification and assessment of splenic injury, alongside any other abdominal viscera involvement. Specifically, it also allows for the grading of the splenic injury to guide further management.

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