Spleen trauma – symptoms, treatment
The spleen is an organ with multiple functions, of which the most significant are:
– The function of defense;
– Autoimmunity function – the synthesis of antibodies;
– Martial function (referring to iron) – iron resulted from red blood cell destruction is stored in the spleen in various forms;
– Hematopoietic role – the spleen is involved in hematopoiesis (the formation and maturation of blood cells) in children;
– Destruction function – of erythrocytes (red blood cells) aging or with structural defects, of leukocytes (white blood cells) and platelets;
– Blood reservoir;
Due to location, the spleen is an organ exposed to both abdominal and chest injuries. Most times, splenic lesions are accompanied by a number of surrounding organ damage.
The most common injuries that can affect the spleen are plagues (by firearms or weapons), contusions (caused by brutal compression, disrupt the continuity of the skin is not disrupted) and rupture, spontaneous rupture of a pathological spleen, iatrogenic trauma during surgery.
The clinical picture of splenic trauma has variable intensity, depending on the degree of injury, degree of bleeding and associated injuries.
Splenic trauma is accompanied by internal hemorrhage. By hemorrhage type there are 4 clinical forms:
– Fulminant form – appears after the desinsertion of spleen or its explosion, the result is massive bleeding with severe prognosis (most patients die within the first hour of the production of lesions);
– Acute form – the patient is agitated, accuses pain in the upper left quadrant, is intensely pale, hemorrhagic shock signs appear – accelerated pulse , sometimes irregular, hypotension, dyspnea (breathing difficulty) with tachypnea (rapid respiratory rate), oliguria, cold profuse sweat, psycho-motor agitation, it can install defensive muscle consecutive to contusion ;
– Two-stroke break – is clinically characterized by moderate pain in left hypochondrium, slightly accelerated pulse, low grade fever and jaundice;
– Secluded hematoma – consists of a collection of blood localized intrasplenic or in splenic lodge, is palpable at left upper quadrant level, it can be detected as a tumor, intensely painful, the patient may complain of nausea, vomiting, loss of appetite.
In terms of investigations, will be made the blood count (which may reveal or not some changes depending on the degree of bleeding), abdominal X-ray (may reveal an increased density in the left upper quadrant with an ascending left hemidiafragm), simple abdominal puncture or with lavage (relevant for haemoperitoneum = blood in the peritoneal cavity), CT, ultrasound, splenic scintigram, selective arteriography (topography and extent of vascular lesions).
Treatment of splenic trauma consists of exploratory laparotomy (open abdominal surgery) followed by splenectomy or active conservative surgery if necessary, depending on case. In addition to surgical treatment is necessary rebalancing fluids by administration of blood, concentrated red blood cells or plasma substitutes.