A ruptured spleen is a medical emergency that occurs when your spleen develops a break in its surface. Your spleen, located just under your rib cage on your left side, helps your body fight infection and filter old blood cells from your bloodstream.
A ruptured spleen is generally caused by a forceful blow to your abdomen — during a sporting mishap, a fistfight or a car crash, for example. Without emergency treatment, a ruptured spleen can cause life-threatening internal bleeding.
Some people with ruptured spleens need emergency surgery. Others can be treated with several days of hospital care.
Signs and symptoms of a ruptured spleen include:
- Pain in the upper left abdomen
- Tenderness when you touch the upper left abdomen
- Left shoulder pain, particularly if you also have cuts and bruises on the left chest or side
- Confusion, lightheadedness or dizziness
When to see a doctor
A ruptured spleen is a medical emergency. Seek emergency care after an injury if your signs and symptoms indicate you may have a ruptured spleen.
A spleen may rupture due to:
- Injury to the left side of the body. A ruptured spleen is typically caused by a blow to the left upper abdomen or the left lower chest, such as might happen during sporting mishaps, fistfights and car crashes. An injured spleen may rupture soon after the abdominal trauma or, in some cases, days or even weeks after the injury.
- An enlarged spleen. Your spleen can become enlarged when blood cells accumulate in the spleen. An enlarged spleen can be caused by various underlying problems, such as mononucleosis and other infections, liver disease, and blood cancers.
A ruptured spleen can cause life-threatening bleeding into your abdominal cavity.
If you've been diagnosed with an enlarged spleen, ask your doctor whether you need to avoid activities that could cause a ruptured spleen. For instance, people with mononucleosis — a viral infection that can cause an enlarged spleen — may be asked to avoid contact sports, heavy lifting and other activities that increase the risk of abdominal trauma for several weeks. Protecting the spleen from bumps and blows may reduce the risk of a ruptured spleen.
Tests and procedures used to diagnose a ruptured spleen include:
- Physical exam. Your doctor will use his or her hands to place pressure on your abdomen to determine the size of your spleen and whether you're experiencing any abdominal tenderness.
- Blood tests. Your doctor will order blood tests to evaluate factors such as platelet count and how well your blood clots.
- Checking for blood in your abdominal cavity. Your doctor may use an ultrasound test to do this. Or he or she may use a needle to draw a sample of fluid from your abdomen. If the sample reveals blood in your abdomen, you may be referred for emergency treatment.
- Imaging tests of your abdomen. If your diagnosis isn't clear, your doctor may recommend an abdominal CT scan or another imaging test to identify or rule out other possible causes of your symptoms.
Treatment for a ruptured spleen will depend on the severity of your condition. Some people with ruptured spleens require immediate surgery. Others may heal with rest and time.
Hospitalization while the spleen heals
Many small and many moderate-sized injuries to the spleen can heal without surgery. You're likely to stay in the hospital while doctors observe your condition and provide nonsurgical care, such as blood transfusions, if necessary.
Your doctor may recommend periodic follow-up CT scans to check whether your spleen has healed or to determine whether you need surgery.
Surgery to repair or remove the spleen
Surgery for a ruptured spleen can include:
- Repairing the spleen. Your surgeon may be able to repair the rupture in your spleen with stitches or other techniques.
- Removing the spleen (splenectomy). With this procedure, your surgeon removes the injured spleen. Complications related to living without a spleen include an increased risk of serious infections, such as sepsis. Risk of sepsis is higher in children and young adults. Your doctor may recommend ways to reduce the risk of infection, such as vaccinations against pneumonia and influenza.
- Removing part of the spleen. If your spleen is ruptured in a way that makes it possible to remove only a portion of it, your surgeon may perform a partial splenectomy. This method helps to avoid the increased risk of infection that results from removing the entire spleen.
These procedures are usually done through several small incisions in your abdomen (laparoscopic surgery). Special surgical tools and a tiny camera with a light are inserted through the incisions. The camera sends images to a monitor, which the surgeon watches in order to guide the surgical tools. In certain situations, the surgeon may use a large incision to access the spleen.
Spleen surgery is generally safe, but any surgery has risks, such as bleeding, blood clots, infection and pneumonia.