What can cause a ruptured spleen. Spleen injury in children

Rupture of the spleen is damage to the organ, which can be caused by both traumatic effects and internal reasons, for example, the development of another pathology in a given area of the body. The most common cause is considered to be injury to the spleen, which can be combined with damage to other nearby organs.

Why does the spleen rupture?

The main causes contributing to pathology include:

Trauma. Nearby organs can also be damaged.
Violation of the metabolic process.
development in the body various kinds infections- viral or bacterial, which can have a direct effect on the change in the size of the organ.
in a progressive organism. This increases the risk of injury during moments of intense physical exertion.
The development of the inflammatory process in the body of a severe degree. These include cirrhosis of the liver or hepatitis.
Overstretching of the abdominal muscles when picking up an object heavy weight. Also, overvoltage can occur at the time of accelerated labor.

This body well enough protected from external pathological influences, but if its strength exceeds the permissible limit, or if the influence of the above factors occurs, the tissues begin to weaken, and the size increases. The result is a gap in the future.

It is worth noting the predisposing factors that can contribute to the occurrence of such a pathology as a rupture of the spleen in a child or in an adult. First of all, these are oncological diseases that occur in the body. With untimely diagnosis of such, thinning and stretching of the organ capsule occurs, which can cause subcapsular rupture of the spleen. With the development of any oncological disease weakening immune system, which is the reason for placing a heavy load on all organs and systems, including the spleen.

Many researchers in the field of medicine have proven that a procedure such as a colonoscopy performed on a person significantly increases the risk of pathology. This method diagnostics allows you to get detailed information about the condition of the mucous membranes of the small intestine.

No less often rupture of the spleen is observed during pregnancy. Due to the growth of the fetus in the womb, the level of pressure in the abdominal region also increases, thereby increasing blood flow to all organs. Even normal, not pathological generic activity can lead to such pathology.

What symptoms occur

If there was a rupture of the spleen, the symptoms immediately make themselves felt. Given the individual characteristics of the organism, as well as the source of the pathology, the symptoms may vary, especially in their intensity. In most cases, the symptoms of a ruptured spleen are confused with completely different pathologies, for example, with gastrointestinal disease.

Associated symptoms are: dizziness, apathy to the outside world, general malaise. If there is frequent nausea and vomiting, may decrease appetite. Also, the patient is worried about constant headaches.

With a weak intensity of the manifestation of symptoms of a particular disease, which may be accompanied by a rupture of the spleen in the future, a person can attribute them to the body's reaction to a change in blood pressure, as well as to normal fatigue after labor day. At this time, the disease progresses. Pain syndrome and other symptoms occur after an increase in the body to a certain size. At this time, the boundaries of blood pressure increase, there is an exacerbation of pain, which is localized in the region of the left hypochondrium. When the organ reaches a certain pathological size, it begins to bulge above the level of the skin.

If the pain syndrome is so strong that a person cannot breathe and move normally, the spleen has ruptured. During this time, there may be a significant increase general temperature, bleeding from the organ occurs, subcutaneous hemorrhages appear over the location of the organ.

Symptoms of organ damage can vary depending on what type of pathology occurs:

rupture, in which there is no significant damage to the parenchyma;
a small degree of damage to the walls of the organ with contusion;
one-stage or two-stage rupture of the spleen;
three-point break.

The most common form of pathology is one-stage, which is characterized by hemorrhage from the organ into the abdominal region.

Diagnostic methods

It is quite difficult to diagnose a pathology that occurs on initial stage. Diagnostics laboratory methods is not used, because based on their results, put accurate diagnosis impossible. You can determine the signs of pathology after the following studies:

x-ray examination;
physical examination (for example, by palpation);
laparoscopy;
measurement of blood pressure indicators.

An x-ray image in the presence of a gap will be able to show a shadow, which is the site of the lesion. Such a shadow will be located in the diaphragmatic zone on the left.
Differential diagnostics is also carried out, which will help to exclude the development of such pathologies similar in symptoms as heart failure, collapse and shock, myocardial infarction, thromboembolism.

Conservative and surgical treatment

If a ruptured spleen is confirmed, the treatment is often surgery. Conservative treatment is only helper method therapy, but may be the main one in some cases:

if the course of the pathology is not progressive, hemodynamics is stable;
hemoglobin is normal within two days after injury to the organ;
no need for blood transfusion;
patients under the age of 55 years.

If, together with such a pathology, nearby organs are also damaged, the operation is performed in without fail, even if at least one of the above factors takes place.

If there is a rupture of the spleen, the operation is performed only after stabilization of hemodynamics: the use of blood substitutes or blood transfusion. If it is impossible to stabilize the condition of the victim, surgical intervention is carried out in critical condition using resuscitation measures.

If the physician deems it necessary, complete removal spleen. AT recent times such an intervention is rarely carried out, to a greater extent resorting to suturing. If the affected area is quite extensive, and also if there are multiple lacerations and through wounds, the only way out is complete removal. During the recovery period after removal, the application is prescribed antibacterial agents and analgesics.

Consequences and prevention

As such, there are no consequences if the spleen bursts. But only if timely medical care is provided and all the doctor's advice is followed in recovery period. If the organ was completely removed, the functions assigned to it in the past will be performed by the liver.

The only thing serious consequence after removal - a significant decrease in the state of the immune system. To correct this state of the body, vitamin preparations are prescribed.

In order to avoid the occurrence of complications, as well as pathology in general, it is recommended to follow some simple recommendations:

in the development of any colds must be respected bed rest, not transferring the disease "on the legs";
during pregnancy, it is necessary to wear a special prenatal bandage, thanks to which you can reduce the load on the organ;
avoid overexertion when performing physical exercises;
avoid road traffic accidents;
recommended to exclude bad habits- alcohol and smoking;
limiting the intake of salted foods;
timely treatment of diseases provoking the disease.

Although a ruptured spleen is not the most dangerous pathology, think that "it will pass by itself" is not worth it. Only qualified help help avoid consequences and increase the chances of leading a normal life in the future.

In surgical practice, this is often dangerous state like a ruptured spleen. It leads to massive bleeding and can cause death of a person. The most common cause is trauma. Similar emergency more often occurs in adults.

Rupture of spleen tissue

The spleen is a lymphoid parenchymal organ. It is located in abdominal cavity behind the stomach. The main functions of this body are:

deposition of blood;
destruction of blood cells;
the process of hematopoiesis;
the formation of lymphocytes.

The spleen is not a vital organ. Despite this, damage to the spleen great danger due to massive blood loss. Rupture of an organ is a common occurrence. In children, it is diagnosed much less frequently. Trauma can be isolated and combined. In the latter case, other organs of the abdominal cavity (intestine, liver) are damaged.

Often the rupture is associated with fractures. various bones and spinal column. Outside, this organ is covered with a capsule. To break, you need to apply great power. The following types of damage to the parenchyma of tissues are known:

contusion;
imaginary gap;
damage with tamponade;
instant break;
minor damage.

In most cases, there is a one-stage type of injury. Its peculiarity is that the capsule and parenchyma are immediately damaged. Slightly less common is a two-stage rupture. It is diagnosed in 13% of patients.

Main etiological factors

Rupture of the spleen in a child and an adult develops as a result of trauma. The reasons may be:

strong blows in the region of the left hypochondrium or chest;
traffic accidents;
falling from height;
fights;
industrial injuries.

Predisposing factors are:

boxing and various martial arts;
increased activity;
extreme sports;
plethora of the spleen;
insufficient muscle development abdominals;
splenomegaly;
looseness of parenchymal tissue;
low mobility of the spleen;
damage to the ribs;
connective tissue weakness;
too thin capsule;
congenital anomalies.

It is very important at what point the injury occurred. The strength of an organ to some extent depends on the volume of blood in it, the phase of respiration, the state of the stomach and intestines, and the time of eating. Sometimes a rupture of the spleen occurs during difficult labor. To more rare reasons include large neoplasms (tumors, cysts).

How does the gap manifest?

Traumatic rupture of the spleen has a specific clinical picture. First, a hematoma is formed. It is located under the capsule. A clot forms, which prevents blood from flowing out. Over time, it disappears and bleeding occurs. The following symptoms are possible:

drop in blood pressure;
pallor of the skin;
pre-fainting state;
thirst;
dry mucous membranes and skin;
weakness;
malaise;
dizziness;
the presence of cold sweat;
increased heart rate.

AT severe cases people are losing consciousness. All of these symptoms are associated with blood loss. It leads to a decrease in the number of red blood cells and hemoglobin. Decreased hematocrit. If the damage is minor, then the symptoms are mild. Signs of a ruptured spleen are:

muscle tension in the anterior abdominal wall;
forced position body;
pain on the left side;
dyspnea;
nausea;
vomit;
noise in ears.

Complaints do not always appear immediately after an injury. A short latency period is possible. To early signs rupture refers pain. It is felt in the left hypochondrium and gives to the shoulder blade or shoulder. Subcapsular rupture with pronounced pain syndrome causes a person to take a forced position of the body.

Most often, such people lie on their back or left side and tighten their legs. When examining a patient, it is revealed that the abdominal muscles do not take part in breathing. Massive blood loss causes anemia. Up to 1/5 of all red blood cells can accumulate in the spleen. There is about 1/10 of the body's blood.

A severe rupture can cause collapse (a pronounced drop in blood pressure) and shock. Very often damage to the spleen leads to intestinal paresis. His motor function is disturbed, which is manifested by the accumulation of gases, fecal retention and flatulence. The heart of the victim tries to restore blood circulation, so compensatory tachycardia occurs.

Possible complications of rupture

The consequences of rupture of the parenchyma of the organ can be very dangerous. The following complications are possible:

intestinal paresis;
anemia;
collapse;
traumatic shock;
dysfunction of vital organs.

With timely surgical care the prognosis is favorable. There is no risk to life. greatest danger represents a gap, combined with crushing of the organ. In this case, there is a risk of developing traumatic shock. Allocate 4 of its degree. Light shock is characterized by pallor of the skin and lethargy of the person.

Consciousness is not disturbed. There is a decrease in reflexes. There may be shortness of breath and increased heart rate. At 2 degrees of shock, a person becomes lethargic. Heart rate reaches 140 per minute. In severe shock, the skin becomes grayish in color. Acrocyanosis is observed. Sticky appears on the body, cold sweat. The pulse often exceeds 160 beats per minute. At 4 degrees of shock, a person loses consciousness. The pulse is not palpable.

Patient examination plan

Diagnosis of a ruptured spleen early stages difficult. Laboratory tests uninformative. Diagnosis requires:

X-ray examination of organs chest;
pressure measurement;
physical examination (percussion, palpation, auscultation);
laparoscopy.

You can see the shadow in the picture. It is located under the diaphragm on the left. The following changes are possible:

bias colon;
change in the location of the stomach;
high standing of the left side of the diaphragm;
expansion of the ventricle.

In order to determine the exact source of bleeding, laparoscopy is performed. It is used to examine the abdominal cavity. Sometimes a laparocentesis is performed. It consists in piercing the anterior abdominal wall. For rate general condition people are organized common clinical tests. Massive blood loss leads to anemia.

Respiratory rate, pulse, blood pressure level are determined. The lungs and heart are heard. Differential Diagnosis performed with shock, collapse, heart failure, myocardial infarction and thromboembolism. Signs of tissue damage in the hypochondrium, pain, symptoms of blood loss, a history of trauma - all this makes it possible to suspect damage to the spleen.

Treatment methods for patients

Restoration of hemodynamics in case of organ rupture should be carried out immediately. The main treatment for these patients is surgery. If necessary, infusion therapy is carried out. According to the indication, transfusion of blood components is carried out. In severe cases, resuscitation is required.

It is very important to properly provide first aid to the victim. You need to do the following:

put the person on their back
ensure complete peace;
call an ambulance;
squeeze soft tissues fist in the region of the left hypochondrium;
apply ice.

In this condition, it is very difficult to stop the bleeding. Hemostatics are not always effective. The most radical method of therapy is splenectomy. During it, the spleen is completely removed. Much less often, a sparing operation is organized, during which the torn off part of the organ is sewn. Any surgical intervention is fraught with the formation of blood clots. To prevent them, antiplatelet agents may be prescribed.

After the operation, antibiotics and painkillers are used. Be sure to continue infusion therapy. Conservative treatment for ruptured spleen is ineffective and can cause complications. If a person has developed shock, then appropriate drugs are prescribed. At low pressure, Dobutamine Admeda or Dopamine Solvay is used. The prognosis is determined by the timeliness of assistance, the degree of rupture and blood loss, as well as concomitant injuries.

Non-specific preventive measures

To prevent a break, you must adhere to the following rules:

exclude any injuries (domestic, industrial, sports);
observe safety precautions;
fasten seat belts while driving;
give up work dangerous species sports;
avoid fights;
stop using alcohol and drugs;
observe the regimen during pregnancy;
wear a bandage when carrying a baby;
avoid heavy lifting.

In most cases, damage to the spleen occurs through the fault of the victim himself. To reduce the risk of accidental incidents, it is necessary to conduct healthy lifestyle life and be more careful. Following safety precautions will help minimize the chance of injury. Splenomegaly must be prevented.

AT similar condition body is more vulnerable. To prevent splenomegaly, it is necessary to prevent bacterial and protozoal diseases (brucellosis, tuberculosis, syphilis, malaria, typhoid fever, leishmaniasis, toxoplasmosis). Often the spleen is affected against the background of helminthiases. In order to prevent organ rupture, it is recommended to strengthen the abdominal muscles and eat right. Thus, rupture of the spleen tissue is dangerous to humans. Timely removal of the organ allows you to cure the patient.

Rupture of the spleen is a condition in which the integrity of this organ is violated. This usually occurs as a result of injury, with a strong blow to the region of the left hypochondrium or in lower part left side of the sternum. Often, rupture of the spleen occurs simultaneously with traumatic injuries. internal organs abdominal cavity. This gives rise to strong pain in the left hypochondrium and symptoms of blood loss.

Tinnitus, dizziness, shortness of breath are some of the symptoms of a ruptured spleen, in which you should immediately seek medical help.

This type of injury is quite common in a fall. high altitude, accident, natural, industrial and railway accidents. Rupture of the spleen can provoke the development of internal bleeding. To prevent development this complication, you need to perform the operation as soon as possible.

Damage to the spleen is observed most often in able-bodied middle-aged people, which is due to their higher physical activity compared to children and the elderly. According to statistics, able-bodied people are more likely to extreme situations at the risk of such injury.

Depending on the number of affected organs, such damage can be:

Isolated, when only the spleen is affected.
Multiple when damage to several organs has occurred.

In most cases, the mesentery, liver and colon are damaged simultaneously with the spleen. There may also be fractures of the ribs and spine, damage to the chest, fractures of the bones and pelvis, craniocerebral trauma. elimination similar pathologies performed by abdominal surgeons and traumatologists.

The spleen is parenchymal organ, which is located on the left side of the abdominal cavity, behind the stomach. This body is not among the vital ones, although it performs a number of important functions. This is the main source of lymphocytes, producing antibodies and destroying old red blood cells and platelets. The spleen also functions as a blood depot.

Symptoms

Symptoms of a ruptured spleen can be very extensive. Manifestations in this case depend on how severe the damage is and how long ago it occurred.

If relatively little time has passed after trauma, then the following symptoms are possible with a rupture of the spleen:

the patient's condition gradually worsens, there are signs of acute blood loss;
pain in the region of the left hypochondrium and upper divisions abdomen
the left shoulder and part of the shoulder blade are painful.

Victims most often lie on their left side or on their backs, tucking their legs. This posture is forced. The abdominal wall does not take part in the breathing process.

Palpation reveals pain in the patient different intensity. The abdominal wall is tense to one degree or another. If a we are talking shock or collapse, the patient's abdominal muscles may be relaxed. With severe internal bleeding, percussion of the abdomen shows dullness of the sound.

A few hours after the injury, the victim develops intestinal paresis. This state accompanied by bloating, gas retention and lack of defecation.

Apart from local symptoms, the patient may have signs of acute progressive blood loss. These include:

pallor;
lowering blood pressure;
cold clammy sweat;
rapid pulse;
nausea and vomiting;
severe weakness that progresses;
tinnitus and shortness of breath;
dizziness.

After some time, the development of motor excitation is possible, after which the patient may lose consciousness. Pulse rises to 120 beats per minute arterial pressure does not reach the mark of 70 mm.

Most of the above symptoms of damage to the spleen do not directly indicate its rupture. They are typical for most traumatic injuries abdominal organs. To establish exact reason bleeding clinical signs won't be enough. This requires professional diagnosis.

The reasons

A careless fall from a height is one of the most common causes ruptured spleen in children

The main cause of rupture of the spleen is a sharp and strong mechanical impact. Most often, this happens in accidents and industrial injuries.

Subcapsular rupture of the spleen can occur in both adults and children. In children, the causes of this pathology are the following factors:

fights, during which the child receives strong blows to the chest area;
traffic accidents;
fall from a great height.

Predisposing factors for the development of splenic rupture in an adult are:

lessons various types martial arts, including boxing;
absence normal development abdominal muscles;
splenomegaly;
increased motor activity;
fullness of the body;
extreme sports;
damage to the ribs;
thin capsule of the spleen;
too loose parenchymal tissue;
the spleen has low mobility.

A ruptured spleen can be caused by difficult childbirth. Less often, the organ is damaged by a large neoplasm, such as a cyst or tumor.

Risk factors

The likelihood of a ruptured spleen is greatly increased by the presence of the following predisposing factors:

the thin capsule of the organ is not strong enough;
the spleen has little mobility;
fullness of the body.

This body is reliably protected from injury by the ribs. However, with a significant mechanical impact, injury may occur. The strength of the spleen depends on such factors:

the position of the victim at the time of physical impact;
the degree of blood filling of the organ;
respiratory phase;
filling the stomach and intestines.

In some patients, rupture of the spleen did not occur even with a fracture of the lower ribs. Naturally, such cases can be considered a happy coincidence, however, the strength of the organ can indeed vary depending on the factors described above.

Classification

Most often, simultaneous ruptures of the spleen are observed with the immediate occurrence of bleeding into the abdominal cavity.

Rupture of the spleen can be of several types:

Capsule rupture. At the same time, significant damage to the parenchyma is not observed.
Contusion. In this case, one of the sections of the parenchyma is torn while maintaining the integrity of the organ capsule.
One-time break. The capsule and parenchyma rupture simultaneously.
Double rupture of the spleen. Initially, damage occurs in the parenchyma, and the capsule ruptures after a certain period of time.
An imaginary two-stage gap. Assumes the development of lesions in the capsule and parenchyma. After that, an independent tamponade is observed. In this case, the bleeding stops even before the patient has a pronounced clinical symptoms, because the blood clot quickly covers the resulting damage. After some time, it is washed out by the blood flow, and therefore the bleeding opens with renewed vigor.
An imaginary three-momentary gap. It suggests the development of a two-stage rupture, after which an independent tamponade is observed. Over time, the patient develops free late bleeding.

Most often, instantaneous ruptures occur, in which there is an instantaneous internal bleeding characterized by the penetration of blood into the abdominal cavity. In this case, the time interval between injury and bleeding can be from an hour to 20 days.

If there is already a subcapsular or central hematoma in the spleen parenchyma, then coughing, sneezing, sudden movements when walking. An increase in pressure in the spleen can also occur when turning in bed.

Two-stage breaks are quite rare. Among all cases closed damage spleen, their share is only 12%.

Most of the gaps are small and are characterized by the presence of blurred symptoms. Therefore, diagnosis is usually carried out no earlier than a few hours after the injury, when the patient's condition deteriorated sharply due to the ongoing loss of blood and its accumulation in the abdominal cavity.

Diagnostics

At present, due to the widespread endoscopic methods Laparoscopy is becoming increasingly important in the diagnosis of ruptured spleen.

On the initial stages the development of pathology, blood tests have little information content. This is due to the fact that, due to the launch of compensation mechanisms, the composition of the blood can remain within normal limits for several hours.

For an accurate diagnosis, it is necessary to perform the following instrumental techniques:

Radiography. X-rays are usually performed in two areas: the chest and the abdomen. The technique allows to detect rupture of the spleen by the following signs: displacement of the left part of the colon, determination of homogeneous tissue on the left under the diaphragm, expansion of the stomach, limitation of spleen mobility.
Laparoscopy. The technique allows for a short time to detect bleeding localized in the abdominal cavity. it endoscopic procedure, thanks to which doctors can determine the source of bleeding.
Angiography. This procedure requires a significant amount of time, and therefore is used in modern diagnostics rupture of the spleen is extremely rare. In addition, it is very difficult to find good equipment and experienced professionals.
Laparocentesis. It is performed if the specialist does not have endoscopic equipment for diagnostics. It involves the implementation of a puncture of the anterior abdominal wall with a special hollow instrument through which a catheter is inserted to perform aspiration (suction) of the contents of the abdominal cavity. Although this technique allows you to identify the presence of bleeding in the abdominal cavity, it is not informative enough to determine its source.

Features of treatment

Since the bleeding that occurs when the spleen ruptures almost never stops on its own, surgery should be performed on early stages development of pathology.

The prognosis is greatly complicated by increasing blood loss. Therefore, doctors should act as quickly as possible.

The classic traumatological technique used for organ rupture is the removal of the spleen. However, on this moment it is also possible to carry out organ-preserving procedures. One of these operations involves suturing wounds of the spleen.

Complete removal of the organ is recommended in the presence of extensive ruptures, crush injuries, through and lacerations, as well as if it is impossible to perform the procedure for suturing the wound. However, experts are trying to do everything possible to preserve the organ, because the spleen plays a number of important functions in the human body.

A ruptured spleen causes a large number blood into the abdominal cavity, which is very painful and life-threatening. A rupture can lead to shock, and ultimately death. These patients usually require immediate surgery.

The spleen is a fist-sized organ located in the upper left quadrant of the abdomen that filters the blood, removing old or damaged red blood cells and platelets from it using specialized white blood cells, and also destroys bacteria and other foreign matter. by opsonization and phagocytosis, as well as the production of antibodies. It also stores about 33% of all platelets.

The spleen is completely covered by a layer of tissue, like a capsule, except for the place where veins and arteries enter the organ (hilum of the spleen). This tissue, called the splenic capsule, helps protect the spleen from immediate injury.

Knowledge of the functions of the spleen is important for the surgeon to be aware of likely consequences splenectomy (cutting out the spleen). Thus, the surgeon must try to preserve the spleen in order to maintain these functions.

Signs of a ruptured spleen

If pain is felt in the abdomen, especially in the area of the left upper quadrant, then this may be a symptom of a rupture. To feel the pain of a ruptured spleen, one must experience a physical blow to the torso of some kind. As a rule, not only the spleen is damaged. The stomach area will also be painful to the touch and inside.

It is necessary to monitor the nature of vision. If there is a sensation of flashes of light in front of the eyes or even blurry vision, this is a classic sign that the spleen is beginning or happening, which means that there is a possibility of severe internal hemorrhage in the abdominal cavity.

It is also necessary to pay attention to mental condition: in case of internal hemorrhage, disorientation and confusion will begin.

Causes of a ruptured spleen

Some diseases can also lead to rupture of the spleen. In such cases, the spleen swells and the capsule that covers it becomes thin, which contributes to rupture if there is a direct blow to the abdomen.

Blood cancers, infections, and metabolic disorders are conditions that can cause the spleen to enlarge. The spleen can also become enlarged as a result of liver disease, such as cirrhosis or cystic fibrosis.

A ruptured non-enlarged spleen can be caused by trauma, such as in an accident. If a person's spleen is enlarged, as is often the case with mononucleosis, most doctors will not allow excessive physical activity (such as contact types sports), in which a blow to the stomach can lead to disaster.

Recent studies also suggest that having a colonoscopy, a procedure to look at the lining of the colon, increases the risk of a ruptured spleen.

Treatment options after a ruptured spleen

As a rule, doctors always remove the damaged spleen. However, removal of the spleen can cause subsequent problems, including increased susceptibility to infections.

The medical community now understands that most small and medium-sized injuries of the spleen can be cured without surgical intervention although a blood transfusion and hospital stay will be required. If surgery is necessary, the entire spleen is usually removed (splenectomy), but sometimes surgeons are able to correct minor injuries.

alternative open operation at less urgent cases removal of the spleen with a laparoscope is considered. A thin tube with a camera (laparoscope) is inserted through a small incision in the anterior abdominal wall in the upper left quadrant. Other instruments are then inserted through other small incisions in order to remove the spleen.

Treatment for the consequences of a ruptured spleen will depend on the severity of the patient's condition. If the doctor understands that the situation is not an emergency, then he may ask the patient to do a blood test and an imaging scan to clearly identify a ruptured spleen. If the tear is not large, the surgeon may be able to repair it without removing the entire organ.

Prevention of rupture of the spleen

A ruptured spleen can be prevented by driving safely or by wearing protective clothing while participating in sports games. Extreme or violent situations in everyday life should be avoided.

Some factors of spleen enlargement can be prevented, such as: alcohol abuse (prevention of liver cirrhosis); malaria prophylaxis should also be carried out when planning a trip to areas endemic for this disease.

The spleen is an unpaired organ of the abdominal cavity, which is the so-called repository of red blood cells. It is located in the left abdomen under the ribs, its borders are clearly limited, but partially in contact with the left kidney. The spleen is not a vital organ human body, but to say that it does not have any important functions is also impossible.

A healthy spleen in the human body performs the function of a specific filter: its cells have a unique ability to destroy foreign organisms, damaged red blood cells or bacteria. In addition, the spleen is involved in the formation of immunity, due to the production of antibacterial bodies that increase the body's resistance to various infections. One of necessary functions this body is involved in the stages metabolic processes: the spleen accumulates iron, which is necessary in the future for the formation of hemoglobin. And, finally, the hematopoietic organ also serves as a specific reservoir, which, if necessary, replenishes the blood flow.

Causes of a ruptured spleen

A rupture of the spleen occurs when an organ or its surrounding tissues are pathologically altered or enlarged due to severe abdominal trauma - the most common cause.

There are several factors besides trauma that can cause a ruptured spleen:

acute pathological conditions caused by various kinds of infections (at the slightest inflammatory processes the load on the organ increases, which can also cause injuries);
superfluous physical activity at existing pathology spleen;
blood flow during childbearing;
rupture of the organ capsule during the birth process due to strong tension in the abdominal muscles (occurs in almost 3-4% of women giving birth).

At chronic diseases any organ or system of the human body increases the load on the spleen. Among the most difficult to tolerate pathologies are such diseases as hepatitis, tuberculosis, cirrhosis or mononucleosis.

A separate category is people developing malignant neoplasms, due to a sharp weakening of the immune system, deterioration of the general condition of the human body, the work of the spleen increases several times.

Symptoms accompanying a ruptured spleen

Due to the fact that the spleen is a hematopoietic organ pathological conditions appear almost the same as with vegetovascular dystonia.

The primary symptomatology manifests itself in the form of such a clinical picture:

weakness;
lethargy;
constant feeling of tiredness;
dizziness;
nausea, sometimes turning into vomiting;
lethargy;
lack of oxygen;
loss of appetite;
lack of sleep.

But, as a rule, few people pay attention to such symptoms, attributing everything to the weather, fatigue after work, and much more.

More vivid symptoms are noted directly with an increase in the spleen in size. The patient is concerned about the feeling of pain in the left side, bursting and pressure. These symptoms are typical for the growth of the spleen. In such cases, the organ can go beyond its boundaries to create pressure on adjacent tissues and other organs.

An acute attack of pain is characteristic of a ruptured spleen. The cause of organ damage can also be calculated by its density; a spleen that is soft in consistency may indicate infection with such types of infections as cholera or typhoid.

It is also possible to suspect a violation in the work of the spleen if the patient has frequent bleeding or subtle bruising.

The most severe stage of the lesion hematopoietic organ accompanied by an increase in body temperature maximum values, confusion and the appearance of ulceration on the lower extremities.

Diagnosis of rupture of the spleen

Detection of rupture of the spleen is a rather difficult process that requires a thorough examination of the patient, the collection of anamnesis, the correct interpretation of the obtained instrumental and laboratory research. It is possible to establish the fact of 100% rupture of the hematopoietic organ only during surgical intervention. Before the operation, the diagnosis can be established in 10-15% of all recorded cases.

The difficulty of diagnosis lies in the fact that the symptoms of injury to the spleen are not specific, they may also indicate any other bleeding localized in the abdominal cavity.

A blood test in the first few hours is not enough, the blood composition remains within the normal range. Diagnosis is based on clinical manifestations, chest x-ray and abdominal x-ray results. On the x-ray image under the dome of the diaphragm, limited enlightenment is clearly visible.

When conducting ultrasound scanning it is very important to have free access to the spleen, since in some cases it is simply impossible to conduct a study due to severe pain when pressing on the area of localization of the organ. The ruptures usually appear as anechoic defects directly at the edge of the spleen and its parenchyma, this is due to the release of blood from the rupture site.

An additional sign of rupture of the spleen is the restriction of mobility in the region of the left dome of the diaphragm. In addition, there is a displacement of the abdominal organs to the left side.

Not last place in the process of establishing a diagnosis of rupture of the spleen, it acquires a method such as laparoscopy. Using this method, it is possible to accurately establish the presence of a rupture accompanied by bleeding, as well as the exact localization of its development. If laparoscopy is not possible, it can be replaced by laparocentesis. It's no less effective method diagnostics. To carry it out, the anterior wall of the abdominal cavity is pierced with a trocar and the liquid is aspirated.

Differential Diagnosis

When establishing a diagnosis - rupture of the spleen, it is very important to fully take into account the clinical picture, the results of instrumental and laboratory studies, and the patient's complaints. It is very important to find out the patient's condition before the injury and in the subsequent period, before admission to a medical institution.

Significant value in case of exclusion possible diseases similar symptoms for rupture of the spleen in a woman has a bimanual study. With the accumulation of a large amount of blood in the pelvis, there is a feeling of tension and severe pain in the anus.

In cases where diagnosis is difficult, a puncture of the Douglas space is performed, with the help of which it is possible to accurately establish the presence of blood in the abdominal cavity, and in combination with the collected anamnesis, one can speak with relative certainty about the presence of a ruptured spleen.

First aid for ruptured spleen

Clear and clearly directed actions to eliminate intra-abdominal bleeding no, however, despite this, it is simply necessary for the patient to provide first aid in case of rupture of the spleen.

Experienced doctors and specialists in such cases can only reduce blood loss due to proper pressure on the abdominal aorta in the area of the solar plexus.

When the first symptoms of a ruptured spleen appear, a number of simple steps should be taken:

lay the patient on his back, preferably on a flat surface;
the victim should not be turned over, forced to stand up, and it is desirable to completely exclude any movements;
to ensure at least the slightest reduction in blood loss, it is necessary to press the area below the sternum with a fist, it is desirable to be in this state until the ambulance arrives;
if possible, left side The abdomen should be covered with ice, this will prevent the spread of bleeding.

The outcome of the injury directly depends on the speed of providing a qualified medical care also important, and the very degree of damage to the body as a whole.

Treatment of a ruptured spleen

The treatment of such a condition as a rupture of the spleen is carried out by surgeons and, in the first stages, in severe cases, resuscitators.

In most cases experienced professionals the damaged organ is urgently removed, however, this entails a number of problems, such as increased susceptibility to various infections. Postponement of surgery is acceptable only in cases where the diagnosis is unclear and it takes time to establish it. In this case, the patient must comply with strict bed rest.

Emergency surgery is performed in intensive care unit. The choice of surgical intervention is determined depending on the nature of the damage. During the operation, specialist doctors try to preserve the tissues of the organ as much as possible. Indications for splenectomy or organ preservation should be well reasoned, taking into account all possible complications.

The purpose of surgery for a ruptured spleen is to stop bleeding. life threatening sick.

Very important in conducting splenectomy is the choice of operative access, all requirements are met by a median laparotomy, with which you can conduct a complete and thorough revision of the organs located in the abdominal cavity.

Stopping bleeding is the first step in providing medical care for a ruptured spleen. The stop can be temporary or immediate, it depends on the condition of the patient directly during the operation. The next step in surgery is pressure stabilization.

In cases where it is impossible to visually determine the place of rupture of the spleen, the organ is examined by palpation. If adhesions of the spleen with the omentum are found, they must be separated, bandaging all large vessels. After the revision, all surgical procedures, drainage is installed, and the wound is sutured.

recovery period in postoperative period in the absence of complications lasts from two to four weeks, recovery depends on the severity of the injuries and individual characteristics organism.

Indications for organ preservation:

single rupture of the capsule;
rupture of one of the poles of the spleen;
minor bruises of the spleen with the formation of subcapsular hematomas.

Surgical intervention for subcapsular hematoma may be limited to suturing the defect and draining the abdominal cavity, namely the subdiaphragmatic space on the left side.

Preventive measures for immunodeficiency states

To avoid the development of an immune system deficiency, the removal of the organ can be compensated by the implantation of spleen tissue. To achieve the desired result, the implant should make up approximately 20% of the organ. It is also equally important to take into account the size of the implanted organ fragments. The tissue must be transplanted directly with the stroma and capsule of the organ.

Postoperative complications:

repeated bleeding;
acute form of pancreatitis;
implant rejection;
violation of the functions of the body;
peritonitis.