Splenic rupture: Difference between revisions
Jump to navigation
Jump to search
| Line 145: | Line 145: | ||
**Blunt traumatic injury (ex: direct impact/blow to the left upper quadrant) | **Blunt traumatic injury (ex: direct impact/blow to the left upper quadrant) | ||
**Indirect traumatic injury (ex: during colonoscopy procedure, splenic capsule tear may occur or it may result in traction on the splenocolic ligament)<ref name="pmid27479605">{{cite journal| author=Jehangir A, Poudel DR, Masand-Rai A, Donato A| title=A systematic review of splenic injuries during colonoscopies: Evolving trends in presentation and management. | journal=Int J Surg | year= 2016 | volume= 33 Pt A | issue= | pages= 55-9 | pmid=27479605 | doi=10.1016/j.ijsu.2016.07.067 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27479605 }} </ref> | **Indirect traumatic injury (ex: during colonoscopy procedure, splenic capsule tear may occur or it may result in traction on the splenocolic ligament)<ref name="pmid27479605">{{cite journal| author=Jehangir A, Poudel DR, Masand-Rai A, Donato A| title=A systematic review of splenic injuries during colonoscopies: Evolving trends in presentation and management. | journal=Int J Surg | year= 2016 | volume= 33 Pt A | issue= | pages= 55-9 | pmid=27479605 | doi=10.1016/j.ijsu.2016.07.067 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27479605 }} </ref> | ||
<small> | |||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="2" |Causes of Splenic Rupture | ! colspan="2" |Causes of Splenic Rupture | ||
| Line 170: | Line 170: | ||
*[[Colonoscopy]] procedure increases the risk of splenic rupture. <ref name="pmid21887533" /><ref name="pmid19009661" /> | *[[Colonoscopy]] procedure increases the risk of splenic rupture. <ref name="pmid21887533" /><ref name="pmid19009661" /> | ||
|} | |} | ||
</small> | |||
'''Traumatic causes:''' | '''Traumatic causes:''' | ||
*Road traffic accidents | *Road traffic accidents | ||
| Line 189: | Line 190: | ||
*Primary and secondary [[amyloidosis]] | *Primary and secondary [[amyloidosis]] | ||
*[[Colonoscopy]] procedure increases the risk of splenic rupture. <ref name="pmid21887533">{{cite journal| author=Fishback SJ, Pickhardt PJ, Bhalla S, Menias CO, Congdon RG, Macari M| title=Delayed presentation of splenic rupture following colonoscopy: clinical and CT findings. | journal=Emerg Radiol | year= 2011 | volume= 18 | issue= 6 | pages= 539-44 | pmid=21887533 | doi=10.1007/s10140-011-0982-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21887533 }} </ref><ref name="pmid19009661">{{cite journal| author=Guerra JF, San Francisco I, Pimentel F, Ibanez L| title=Splenic rupture following colonoscopy. | journal=World J Gastroenterol | year= 2008 | volume= 14 | issue= 41 | pages= 6410-2 | pmid=19009661 | doi= | pmc=2766127 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19009661 }} </ref> | *[[Colonoscopy]] procedure increases the risk of splenic rupture. <ref name="pmid21887533">{{cite journal| author=Fishback SJ, Pickhardt PJ, Bhalla S, Menias CO, Congdon RG, Macari M| title=Delayed presentation of splenic rupture following colonoscopy: clinical and CT findings. | journal=Emerg Radiol | year= 2011 | volume= 18 | issue= 6 | pages= 539-44 | pmid=21887533 | doi=10.1007/s10140-011-0982-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21887533 }} </ref><ref name="pmid19009661">{{cite journal| author=Guerra JF, San Francisco I, Pimentel F, Ibanez L| title=Splenic rupture following colonoscopy. | journal=World J Gastroenterol | year= 2008 | volume= 14 | issue= 41 | pages= 6410-2 | pmid=19009661 | doi= | pmc=2766127 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19009661 }} </ref> | ||
==Risk Factors== | ==Risk Factors== | ||
Revision as of 22:14, 20 December 2017
Template:DiseaseDisorder infobox
|
WikiDoc Resources for Splenic rupture |
|
Articles |
|---|
|
Most recent articles on Splenic rupture Most cited articles on Splenic rupture |
|
Media |
|
Powerpoint slides on Splenic rupture |
|
Evidence Based Medicine |
|
Clinical Trials |
|
Ongoing Trials on Splenic rupture at Clinical Trials.gov Trial results on Splenic rupture Clinical Trials on Splenic rupture at Google
|
|
Guidelines / Policies / Govt |
|
US National Guidelines Clearinghouse on Splenic rupture NICE Guidance on Splenic rupture
|
|
Books |
|
News |
|
Commentary |
|
Definitions |
|
Patient Resources / Community |
|
Patient resources on Splenic rupture Discussion groups on Splenic rupture Patient Handouts on Splenic rupture Directions to Hospitals Treating Splenic rupture Risk calculators and risk factors for Splenic rupture
|
|
Healthcare Provider Resources |
|
Causes & Risk Factors for Splenic rupture |
|
Continuing Medical Education (CME) |
|
International |
|
|
|
Business |
|
Experimental / Informatics |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Rupture of the capsule of the spleen, an organ in the upper left part of the abdomen, is a potential catastrophe that requires immediate medical and surgical attention.
Historical Perspective
Classification
- American Association for the Surgery of Trauma (AAST) Spleen Trauma Classification: [1]
| American Association for the Surgery of Trauma (AAST) Spleen Trauma Classification | ||
|---|---|---|
| Grade | Injury description | |
| I | Hematoma | Subcapsular, < 10% surface area |
| Laceration | Capsular tear, < 1 cm parenchymal depth | |
| II | Hematoma | Subcapsular, 10–50% surface area |
| Intraparenchymal, < 5 cm diameter | ||
| Laceration | 1–3 cm parenchymal depth not involving a perenchymal vessel | |
| III | Hematoma | Subcapsular, > 50% surface area or expanding |
| Ruptured subcapsular or parenchymal hematoma | ||
| Intraparenchymal hematoma > 5 cm | ||
| Laceration | > 3 cm parenchymal depth or involving trabecular vessels | |
| IV | Laceration | Laceration of segmental or hilar vessels producing major devascularization (> 25% of spleen) |
| V | Laceration | Completely shatters spleen |
| Vascular | Hilar vascular injury which devascularized spleen | |
- WSES Spleen Trauma Classification for adult and pediatric patients:[1]
| WSES Class | Mechanism of injury | AAST | Hemodynamix Status | CT scan | First-line treatment in adults | First-line treatment in pediatric | |
|---|---|---|---|---|---|---|---|
| Minor | WSES I | Blunt/penetrating | I - II | Stable | Yes + local exploration in SW | NOM + serial clinical/laboratory/radiological evaluation
Consider angiography/angioembolization |
NOM + serial clinical/laboratory/radiological evaluation |
| Moderate | WSES II | Blunt/penetrating | III | Stable | Consider angiography/angioembolization | ||
| WSES III | Blunt/penetrating | IV - V | Stable | NOM All angiography/angioembolization + serial clinical/laboratory/radiological evaluation | |||
| Severe | WSES IV | Blunt/penetrating | I - V | Unstable | No | OM | OM |
| SW - Stab wound; GSW - Gunshot wound; OM - Operative management; NOM - Non-Operative management | |||||||
Pathophysiology
- The spleen is located in the upper left part of the abdomen (left-upper quadrant, left rib cage, or left flank) which helps in filtering the blood and removes old and damaged blood cells and platelets. The spleen also helps the immune system in the destruction of bacteria and removal of foreign substances. In adults, the spleen weighs 250 gms in weight and measures 13 cm in length. It has been observed that the spleen involutes with the increasing age and it isn't easily palpable in the adults when compared to children.
- As the spleen is a high vascular organ, it makes it susceptible to bleeding from the arteries, veins or parenchyma in an event of injury to it.
- The spleen is a highly vascularized organ, and an injury to this organ can result in significant blood loss either from the parenchyma or the arteries and veins that supply the spleen. Spleen also serves as an important lymphopoietic organ. Normal functioning of the spleen plays a major role in the opsonization of encapsulated organisms.
- Functions of the spleen include:
- Hematologic function
- Immunologic function
- Hematologic function:
- Red cell maturation
- Phagocytosis (Extraction of abnormal cells)
- Remove particulates such as opsonized bacteria, or antibody-coated cells from blood
- Immunologic function:
- Contributes to the humoral and cell-mediated immunity
Causes
- The spleen is injured in an event of trauma to the lower left chest or the upper left abdomen. [2] [3]
- The nature of traumatic injury may be :
- Penetrating traumatic injury (ex: abdominal gunshot wounds)
- Blunt traumatic injury (ex: direct impact/blow to the left upper quadrant)
- Indirect traumatic injury (ex: during colonoscopy procedure, splenic capsule tear may occur or it may result in traction on the splenocolic ligament)[4]
| Causes of Splenic Rupture | |
|---|---|
| Traumatic causes | Non-Traumatic causes |
|
|
Traumatic causes:
- Road traffic accidents
- Contact sports injuries (Hockey and Football)
- Stab and gunshot wounds
- Domestic violence
- Fist fights
Non-Traumatic causes:
- Pancreatitis (Acute and Chronic)
- Lymphoma (malignant haematological disorders)
- Leukaemia (malignant haematological disorders)
- Splenic neoplasms such as the angiosarcoma and haemangioma
- Langerhans cell histiocytosis (non-malignant haematological disorders)
- Viral infections such as the infectious mononucleosis, HIV and cytomegalovirus (CMV) infection
- Bacterial infections such as the infectious endocarditis and tuberculosis
- Parasitic infections such as the malaria
- Primary and secondary amyloidosis
- Colonoscopy procedure increases the risk of splenic rupture. [5][6]
Risk Factors
Screening
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
History
Symptoms
Symptoms of Splenic rupture include: [1] [7] [8] [9] [10]
- Upper left abdominal pain
- Upper left abdominal tenderness
- Left shoulder pain (Sharp pain - Kehr's sign)
- Confusion, dizziness and lightheadedness
- Blurred vision
- Tachycardia ("racing heart" feel)
- Profuse sweating
- Dyspnea
- Extensive injury may result in excessive bleeding leading to hypotension and finally hypovolemic shock
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography or Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ 1.0 1.1 1.2 Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE; et al. (2017). "Splenic trauma: WSES classification and guidelines for adult and pediatric patients". World J Emerg Surg. 12: 40. doi:10.1186/s13017-017-0151-4. PMC 5562999. PMID 28828034.
- ↑ Hildebrand DR, Ben-Sassi A, Ross NP, Macvicar R, Frizelle FA, Watson AJ (2014). "Modern management of splenic trauma". BMJ. 348: g1864. doi:10.1136/bmj.g1864. PMID 24696170.
- ↑ Aubrey-Bassler FK, Sowers N (2012). "613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review". BMC Emerg Med. 12: 11. doi:10.1186/1471-227X-12-11. PMC 3532171. PMID 22889306.
- ↑ Jehangir A, Poudel DR, Masand-Rai A, Donato A (2016). "A systematic review of splenic injuries during colonoscopies: Evolving trends in presentation and management". Int J Surg. 33 Pt A: 55–9. doi:10.1016/j.ijsu.2016.07.067. PMID 27479605.
- ↑ 5.0 5.1 Fishback SJ, Pickhardt PJ, Bhalla S, Menias CO, Congdon RG, Macari M (2011). "Delayed presentation of splenic rupture following colonoscopy: clinical and CT findings". Emerg Radiol. 18 (6): 539–44. doi:10.1007/s10140-011-0982-3. PMID 21887533.
- ↑ 6.0 6.1 Guerra JF, San Francisco I, Pimentel F, Ibanez L (2008). "Splenic rupture following colonoscopy". World J Gastroenterol. 14 (41): 6410–2. PMC 2766127. PMID 19009661.
- ↑ Barone JE, Burns G, Svehlak SA, Tucker JB, Bell T, Korwin S; et al. (1999). "Management of blunt splenic trauma in patients older than 55 years. Southern Connecticut Regional Trauma Quality Assurance Committee". J Trauma. 46 (1): 87–90. PMID 9932688.
- ↑ Beuran M, Gheju I, Venter MD, Marian RC, Smarandache R (2012). "Non-operative management of splenic trauma". J Med Life. 5 (1): 47–58. PMC 3307080. PMID 22574087.
- ↑ Pachter HL, Guth AA, Hofstetter SR, Spencer FC (1998). "Changing patterns in the management of splenic trauma: the impact of nonoperative management". Ann Surg. 227 (5): 708–17, discussion 717-9. PMC 1191351. PMID 9605662.
- ↑ Cadeddu M, Garnett A, Al-Anezi K, Farrokhyar F (2006). "Management of spleen injuries in the adult trauma population: a ten-year experience". Can J Surg. 49 (6): 386–90. PMC 3207549. PMID 17234065.
Template:Injuries, other than fractures, dislocations, sprains and strains