Because of the spleen’s position in the upper left side of the abdomen, a severe blow to the stomach area can damage the spleen, tearing its covering, the tissue inside, or both.
(See also Overview of Abdominal Injuries.)
The tears range from small ones that stop bleeding spontaneously to very large ones that cause potentially fatal bleeding. Sometimes a collection of blood (hematoma) forms under the covering of the spleen or deep within it.
The spleen is the most commonly injured organ in the abdomen as a result of motor vehicle crashes, falls from a height, athletic mishaps, and beatings. Sometimes other abdominal organs also are damaged. Enlargement of the spleen (for example, due to Epstein-Barr virus causing infectious mononucleosis) makes the spleen more susceptible to injury.
When the spleen is injured, blood may be released into the abdomen. The amount of bleeding depends on the size of the injury. A hematoma of the spleen does not bleed into the abdomen at first but may rupture and bleed in the first few days after injury, although rupture sometimes does not occur for weeks or months.
An injured or ruptured spleen can make the abdomen painful and tender. Blood in the abdomen acts as an irritant and causes pain. The pain is in the left side of the abdomen just below the rib cage. Sometimes the pain is felt in the left shoulder. The abdominal muscles contract reflexively and feel rigid. If enough blood leaks out, blood pressure falls and people feel light-headed, have blurred vision and confusion, and lose consciousness (faint).
When ribs on the left side are fractured, doctors may observe the person carefully for a spleen injury.
Doctors usually do ultrasonography or computed tomography (CT) of the abdomen if they suspect an injury to the spleen. Rarely, if doctors suspect a severe hemorrhage, surgery is done immediately to make a diagnosis and control the bleeding. People with severe bleeding also are given intravenous fluids and sometimes blood transfusions.
Doctors used to always remove a damaged spleen. However, removing the spleen can cause later problems, including an increased susceptibility to dangerous infections. Doctors now realize that most small and moderate-sized injuries to the spleen can heal without surgery, although blood transfusions are sometimes required and people must be treated in the hospital. When surgery is necessary, usually the entire spleen is removed (splenectomy), but sometimes surgeons are able to repair a small tear.
After a splenectomy, certain precautions are needed to prevent infections (see Asplenia).