Ruptured spleen

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 29, 2016
StartDiseasesRuptured spleen

The spleen is a delicate blood-filtering organ located under the left rib cage near the stomach. When a ruptured spleen occurs, internal bleeding ensues and immediate medical attention is required. Surgery may be necessary in some cases, but smaller injuries may simply be monitored while healing occurs.


Definition & Facts

A ruptured spleen occurs when the thin layer of tissue covering the spleen is torn and blood from the spleen leaks into the abdomen. If the tear is major, the internal hemorrhaging can be life-threatening.

Injuries to the spleen are typically caused by blunt force trauma, such as might be caused by a car accident or blow to the stomach, rather than penetrating injuries such as would be caused by a stabbing or gunshot wound.

Symptoms & Complaints

Symptoms of a ruptured spleen include pain and tenderness in the left side of the body below the rib cage. It's also possible to feel pain in the left shoulder region, as nerves in this area can become irritated by the rupture. This is known as Kehr's sign, and is a very common symptom. The level of pain can vary depending on the severity of the injury. Muscles in the abdomen may also tense and become rigid.

If enough blood leaks into the abdomen, signs of shock may also manifest. These may include symptoms such as the patient feeling lightheaded, having low blood pressure, breathing rapidly, experiencing dizziness, and also feeling confusion. Blurred vision, anxiety, paleness, and loss of consciousness are also possible.

Patients experiencing these symptoms should not ignore them, as severe internal bleeding can be fatal in many cases. Immediate medical attention to diagnose and treat the injury to the spleen is necessary.


A ruptured spleen is typically caused by trauma which may occur from a variety of accidents. Car crashes, domestic violence, and sports injuries are all possible causes. A blow to the stomach or rib cage area is generally to blame, although rupture doesn't always occur immediately and may follow several days or even weeks after the initial injury occurred.

An enlarged spleen can also rupture, and this is caused by blood cells accumulating within the spleen. There are a variety of issues which can cause a spleen to be enlarged, including liver diseases, medical procedures such as colonoscopy, blood cancers, and infections such as mononucleosis. Because an enlarged spleen is swollen, the tissue covering the spleen is thinner than usual and more fragile, increasing the risk of injury and rupture.

Diagnosis & Tests

To diagnose a ruptured spleen, doctors will use a variety of tests and scans. A physical examination may take place to determine the size of the spleen, as well as to test the area for pain or tenderness. Blood tests can show platelet count and clotting ability, as well as blood loss.

If an injury to the spleen is suspected, it is likely that a computed tomography (CT) scan of the abdominal region may be performed. To administer these tests, the doctor injects a substance into a vein, typically into the patient's arm. This substance, called contrast, helps the blood show up on the scan so that any bleeding from the spleen can be spotted and the amount can be determined. In some cases, patients may have magnetic resonance imaging (MRI)s taken.

However, these procedure takes some amount of time, so treatment will be administered prior to diagnosis in severe cases where the patient is showing signs of shock or his or her vital signs seem to be unstable. In these cases, emergency surgery is performed immediately to prevent the rupture from causing any more damage or death.

One diagnostic test that can be administered at the point of care is a focused abdominal sonographic technique (FAST). This is an ultrasound test which detects a buildup of fluid in the abdomen. True to its acronym, FAST can be administered rapidly and is therefore useful in emergency situations.

Treatment & Therapy 

In the past, the standard response to a ruptured spleen was the immediate and total removal of the spleen (splenectomy). While surgical removal of the spleen is still necessary in many instances, other treatments are sometimes used if the injury is minor and the doctor chooses to try and save it. This is because removing the patient's spleen can result in future issues including a weakened immune system. Although it is possible to live without a spleen and to increase immunity through extra vaccines and antibiotics, infections and bacteria will still pose more of a threat to people without a spleen.

In most cases where surgery is needed, the spleen is removed, but sometimes it is possible to remove only a portion of the spleen, or to repair the tears instead. Repairs are made by placing stitches in the torn portion, as well as putting pressure on blood vessels or the spleen itself until the blood clots and stops leaking into the abdominal cavity.

When the injury to the spleen is minor enough, no surgery at all is needed. Patients may still receive blood transfusions, and they will still require careful monitoring at a hospital. Follow-up scans may be necessary to determine whether the spleen is healing well or whether further treatment and possibly surgery are needed.

Prevention & Prophylaxis

Because injury to the spleen is typically caused by trauma, commonsense injury prevention and everyday precautions can help reduce the risk of a ruptured spleen. This includes measures such as safe driving habits and wearing proper safety gear while playing sports.

For patients who have an enlarged spleen, or who may be at risk of an enlarged spleen due to another condition, further precautionary measures may be wise. Patients who may have an enlarged spleen should ask their doctors whether activities such as heavy lifting or contact sports are safe for them to engage in. If injury to the spleen is suspected, immediate medical help should be sought.