The spleen is a delicate, fist-sized organ under your left rib cage near your stomach. It contains special white blood cells that destroy bacteria and help your body fight infections. The spleen also makes red blood cells and helps remove, or filter, old ones from the body's circulation.
A layer of tissue entirely covers the spleen in a capsule-like fashion, except where veins and arteries enter the organ. This tissue, called the splenic capsule, helps protect the spleen from direct injury.
A ruptured spleen is an emergency medical condition that occurs when the capsule-like covering of the spleen breaks open, pouring blood into your abdominal area. Depending on the size of the rupture, a large amount of internal bleeding can occur.
Your doctor may refer to a ruptured spleen as a "splenic rupture."
What Causes a Ruptured Spleen?
The spleen can rupture when the abdomen suffers a severe direct blow or blunt trauma. The spleen is the most frequent organ to be damaged in blunt trauma injuries involving the abdomen. That's true regardless of your age.
The following are among the frequent causes of spleen injuries:
Motor vehicle accidents
Injury during contact sports, such as football and hockey
Bicycle accidents, such as falling into your bicycle's handlebars
Certain diseases and illnesses can also lead to a ruptured spleen. In such cases, the spleen becomes swollen and the capsule-like covering becomes thin. This makes the organ especially fragile and more likely to rupture if the abdomen receives a direct hit (such as forceful football tackle).
Diseases that increase the risk for a ruptured spleen include:
Blood (hematological) diseases such as hemolytic anemia and certain types of lymphoma
Recent studies have also linked colonoscopy, a procedure that looks at the large intestine, to an increased risk of a ruptured spleen.
Symptoms of a Ruptured Spleen
A ruptured spleen causes abdominal pain, usually severe, but not always. The severity and even the location of the pain depend on how badly the spleen has ruptured and how much blood leaks out. Pain may be felt in these locations:
Left side of the abdomen under the rib cage
Left shoulder, because nerves of the left shoulder and left side of the diaphragm originate from the same location and the rupture may irritate these nerves
Internal bleeding caused by the ruptured spleen can cause blood pressure to drop. This can cause:
Signs of shock, including restlessness, anxiety, nausea, and paleness
How Is a Ruptured Spleen Diagnosed?
A physical exam may be the only test done to diagnose a ruptured spleen. The doctor will feel the person's belly area. The abdominal area may feel hard and look swollen (distended) because it has filled with blood. If there has been a great deal of blood loss from the spleen, the patient may have low blood pressure and a rapid heart rate. Sudden low blood pressure in someone who is believed to have a spleen injury, particularly a young person, is a sign that the condition is especially severe, and emergency surgery is needed.