Spleen injury

Spleen injury

Damage types

    • Penetrating wounds (knife, gunshot). Injury to the spleen can occur with injuries to the abdomen, middle or lower chest.
    • Blunt blunt trauma is more common in motor vehicle accidents. Damage to the spleen leads to profuse internal bleeding and shock. In 5% of cases with blunt trauma, rupture of the spleen may be delayed (2-stage)
    • Two moment break
    • First, a subcapsular hematoma occurs. As a result of the lysis of red blood cells, the osmolarity of the contents of the hematoma increases, which

leads to its increase and rupture of the wall (capsule of the spleen)

    • Approximately 75% of delayed ruptures occur 2 weeks after the primary injury and manifest as acute shock resulting from profuse internal bleeding.
    • Iatrogenic injuries are formed due to strong traction for the splenic ligaments or incorrect position of retractors during abdominal operations. In 20% of cases, the indication for splenectomy is iatrogenic injury.
    • Spontaneous ruptures appear as a result of splenomegaly of various origins (for example, with mononucleosis, leukemia, malaria).

Clinical picture

    • Internal bleeding and shock: pallor of the skin, cold sweat, tachycardia, decrease in blood pressure, Hb, Ht with accumulation of blood in the subdiaphragmatic space – a symptom of a roly-poly-stand (increased pain when the patient is in a horizontal position, dullness of percussion sound in sloping areas of the abdominal cavity)
    • Symptoms of peritoneal irritation: muscle tension of the abdominal wall, symptoms of Shchetkin-Blumberg, Voskresensky, etc.
    • When the chest cavity is injured, there are signs of pneumo- and hemothorax.

Treatment:. It is not often possible to save an organ, only with superficial and minor injuries.

    • With small ruptures of the capsule, bleeding can sometimes be stopped by electrocoagulation and the application of a hemostatic sponge.
    • Splenectomy is the method of choice for massive injuries, especially in combination with damage to other organs.
    • Indications for splenectomy: extensive trauma to the spleen, bleeding from dilated veins of the esophagus caused by thrombosis of the splenic veins
    • Complications after splenectomy
    • Atelectasis of the lower lobe of the left lung (common)
    • Subdiaphragmatic abscess in combination with left-sided effusion pleurisy
    • Postsplenectomy sepsis. The disease begins with nonspecific symptoms resembling moderate pneumonia, then high fever appears, shock is possible. In adults who have undergone splenectomy due to trauma, the risk of developing sepsis cocfa is 0.5-0.8%.

See also Hemothorax, Pneumothorax, Abdominal trauma, Trauma

chest, shock

ICD. S36.0 Injury of spleen

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