How it develops
Splenic trauma occurs most often after a road traffic accident, fall, sporting injury, or a strong impact to the upper left abdomen or left ribs. It can range from a minor injury to a deep rupture with bleeding into the abdomen. More rarely, rupture can occur without obvious trauma when the spleen is significantly enlarged, for example in an infectious or hematological condition.
Symptoms
Pain in the upper left abdomen, tenderness beneath the left ribs, and pain referred to the left shoulder are common symptoms. Dizziness, weakness, faintness, rapid heart rate, pallor, or low blood pressure may indicate significant internal bleeding.
Diagnosis and treatment
Immediate clinical assessment and monitoring of vital signs are essential. In hemodynamically stable patients, contrast-enhanced CT assesses the severity of the injury, active bleeding, and possible associated injuries. In emergency situations, FAST ultrasound may be used.
Many stable patients are managed without an operation, with admission, clinical monitoring, repeat blood tests, and imaging when needed. If CT shows active bleeding or a pseudoaneurysm, angiography and splenic artery embolization may be performed. Emergency surgery, often splenectomy, is required when there is hemodynamic instability or uncontrolled bleeding.
Frequently asked questions
Can the injury be managed without surgery?
Yes, provided that the patient is stable and the injury allows it. The decision is based on the overall condition, CT findings, and the ability to provide close monitoring.
When can I return to exercise?
Return is gradual and only with medical advice. Timing depends on the severity of the injury and the course of follow-up investigations.
Which symptoms after discharge are urgent?
Worsening pain, dizziness, fainting, rapid heart rate, fever, or new weakness require urgent assessment.
When to seek medical attention
After a significant blow to the left upper abdomen or lower left ribs, go to an emergency department the same day, even if you feel reasonably well at first. Call 112 if there is faintness, a racing heart, pallor, severe pain, or pain at the tip of the left shoulder. Internal bleeding from the spleen is not always obvious at the start, and it can worsen over hours or, less often, days.
If you have been discharged after a splenic injury, return at once for new or worsening abdominal pain, dizziness, or fainting.
What the assessment involves
The team checks pulse, blood pressure and oxygen levels, examines the abdomen, and takes blood tests, including hemoglobin and a blood group. A bedside ultrasound looks for free blood in the abdomen. If the patient is stable, a contrast CT scan shows the injury and whether there is active bleeding.
Injuries are graded from minor to severe. The grade, together with how stable the patient is, guides the choice of treatment.
Treatment options
Most patients who are stable are treated without an operation. They stay in hospital under close observation with repeat blood tests, rest and, if needed, blood transfusion. If there is ongoing bleeding inside the spleen, a radiologist can block the bleeding vessel through a small catheter (angioembolization). Surgery is needed if the patient becomes unstable or other injuries require it. The aim is to repair or partly remove the spleen where possible, and to remove it completely when bleeding cannot otherwise be controlled.
Recovery and follow-up
Recovery depends on the grade of injury and the treatment. Contact sport and heavy physical exertion are usually avoided for several weeks to a few months, until the surgeon confirms healing, sometimes with a repeat scan. If the spleen has been removed, the vaccination and fever advice in the splenectomy article applies.
More questions about splenic injury
Will I lose my spleen?
Not necessarily. Keeping the spleen is preferred when it is safe. The decision depends on your stability, the grade of injury and other injuries.
Can bleeding start again later?
Delayed bleeding is uncommon but possible in the first weeks. That is why the warning symptoms above matter after discharge.
