Description

When a substantial impact to the spleen from an outside cause destroys or ruptures the spleen, it is called blunt splenic trauma. Treatment varies depending on the severity, although embolism or splenectomy is frequently used. An embolism occurs when a blockage-causing particle of material lodges inside a blood vessel. A blood clot (thrombus), a fat globule (fat embolism), a bubble of air or other gas, amniotic fluid (amniotic fluid embolism), or foreign material can all cause an embolus. An embolism can restrict blood flow in a vessel, either partially or completely. An embolus obstruction might affect a portion of the body that is far away from the source of the embolus. A thromboembolism is an embolism in which the embolus is a fragment of thrombus.

Signs and Symptoms of Hemorrhage

Hemorrhage is the most common symptom, and it manifests variously depending on the severity of the injury, with significant haemorrhage, shock, abdominal discomfort, and distention being clinically noticeable. Minor bleeding frequently manifests as pain in the upper left quadrant. Patients with unexplained left upper quadrant discomfort are frequently asked about recent trauma, especially if there is evidence of hypovolemia or shock. Internal haemorrhage is the main worry with any splenic trauma, albeit the amount of haemorrhage might vary according on the origin and severity of the damage. Small or small injuries, especially in youngsters, often heal on their own. Larger wounds bleed profusely, resulting in hemorrhagic shock. A splenic hematoma can rupture at any time, generally within the first few days, though it can happen at any time from hours to months after injury. The most common occurrence of blunt splenic trauma is in car accident patients, where it is a leading source of internal bleeding. Splenic trauma can occur as a result of any significant impact on the spleen. When the handlebar is driven into the left subcostal margin and into the spleen during a bicycle collision, this can happen. Sub-capsular hematoma to splenic rupture is all possible injuries.  The diagnosis is confirmed with a CT scan or, in the case of less stable individuals, a bedside ultrasound. Exploratory laparotomy is rarely utilised, however it may be useful in assessing for retroperitoneal hematomas in patients with extremely severe haemorrhage.

An exploratory laparotomy allows doctors to examine the four quadrants of the abdomen for any perforations, vascular injuries, or anomalies, as well as the bowel. To determine the necessity for intervention in patients with splenic injury, a set of CT scan grading criteria was developed. The criteria were developed using 20 CT scans from a database of patients with traumatic splenic injury who were hemodynamically stable. The study suggested that the following three CT findings correlate with the need for intervention: Splenic parenchyma de vascularization or laceration involving 50% or more of the parenchyma, a contrast blush with a diameter of more than one centimeter, the presence of a big hemoperitoneum.

Splenectomy has long been the standard treatment. In order to mobilise the spleen, three splenic attachments are ligated. Laterally the splenorenal ligament, inferiorly, and superiorly, the splenocolic ligament, inferiorly and superiorly, the splenophrenic ligament are situated. Suture ligation of the splenic blood supply follows. The abdomen is irrigated with normal saline after the spleen is removed to ensure hemostasis. Following confirmation, the abdominal organs are placed in their proper anatomical positions, and the abdomen is closed. However, splenectomy should be avoided if at all possible, especially in children, to avoid a lifetime of bacterial infection susceptibility. In stable patients, the majority of small and moderate-sized lacerations are treated with hospital observation and occasionally transfusion rather than surgery. Embolization, or the blockage of bleeding vessels, is a newer and less intrusive procedure. The spleen can be surgically repaired in a few cases, although splenectomy remains the most common surgical treatment, with the best success rate of all therapies.

Increase in Blood Leukocytes

Splenectomy increases the risk of sepsis, especially post-splenectomy sepsis, which is caused by encapsulated organisms such S. pneumonia and Haemophilus influenza that can no longer be killed. It has been discovered that a splenectomized patient's chance of developing sepsis is 10 to 20 times higher than a non-splenectomized patient's risk of developing sepsis, which can lead to death, especially in small children. Post-operatively, patients are given the pneumococcal conjugate vaccination (Prevnar), the Hib vaccine, and the meningococcal vaccine. Under normal circumstances, these bacteria create a sore throat, but after splenectomy, when invading microorganisms cannot be effectively opsonized, the infection becomes more severe.

A splenectomy can result in an increase in blood leukocytes. Platelet counts may rise excessively high after splenectomy (thrombocytosis), increasing the risk of possibly deadly clot formation. Due to the lack of platelet sequestration and destruction that the spleen ordinarily does, mild thrombocytosis may develop after a splenectomy. Furthermore, a splenectomy may result in a modest increase in platelet production in the bone marrow. The spleen stores and removes erythrocytes from the circulating blood in normal circumstances, including damaged erythrocytes.

Due to the absence of the spleen following a splenectomy, this function cannot be performed, resulting in injured erythrocytes continuing to circulate in the circulation and releasing chemicals into the blood. If these injured erythrocytes contain procoagulant activity, the compounds they release can produce a procoagulant state, which can result in thromboembolic events such as pulmonary embolism, portal vein thrombosis, and deep vein thrombosis. There is also speculation that people who have had their splenectomy may be at a higher risk of getting diabetes in the future. Chronic neutrophilia can also be a side effect of splenectomy. Howell-Jolly bodies and, less occasionally Heinz bodies are found in the blood smears of splenectomy patients.