How Is a Ruptured Spleen Diagnosed? continued...
How Is a Ruptured Spleen Diagnosed?
Imaging tests can help diagnose a ruptured spleen. A computed tomography (CT) scan of the abdomen is one of the most common methods used. During the test, a special substance, called contrast, is injected into a vein, usually in the arm. The contrast helps the doctor determine the amount of bleeding from the spleen. Active bleeding from the spleen may not be seen on an abdominal CT scan without contrast.
However, a CT scan of the abdomen may only be done if time allows. A CT scan with contrast may take awhile, and some people with spleen ruptures have died while waiting to have the test done. For this reason, a CT scan is not recommended for those with a spleen rupture who have unstable vital signs or low blood pressure due to the injury (suggesting shock).
Other people are allergic to CT contrast or cannot receive it because their kidneys do not work properly.
In these cases, other tests may be used to help diagnose a spleen rupture. They include:
Focused abdominal sonographic technique (FAST). This is an ultrasound method to check for fluid buildup in the abdominal area. It can be used to help diagnose a ruptured spleen in unstable patients, but studies have found CT to be better in an emergency setting.
Diagnostic peritoneal lavage. This is a method to rapidly determine if blood is gathering in the abdominal area. It is fast and inexpensive, and can be done on spleen rupture patients who have low blood pressure.
MRIof the abdomen. This may be an option for patients with kidney failure or who have severe allergies to the contrast substance used during a CT scan.
If the person is stable and does not need emergency surgery, laboratory tests such as a complete blood count (CBC) or hemoglobin level may be done at routine intervals to check for blood loss.
How Is a Ruptured Spleen Treated?
In the past, treatment for a spleen injury always meant removal of the entire organ, called a splenectomy. However, doctors now say that some spleen injuries can heal on their own, particularly those that are not very severe. People with spleen injuries who do not need surgery must still be monitored in a hospital, and they may need blood transfusions.
Immediate, emergency surgery to remove or repair the spleen is done in the following cases:
- If the doctor thinks there is massive internal bleeding
- If a person with a suspected spleen rupture has low blood pressure or unstable vital signs
When surgery is done, the entire spleen is still usually removed. But in the case of small tears, the surgeon may try to save the spleen instead. This involves repairing the tear and putting pressure on the spleen or blood vessels till the blood clots and stops the leak. Another procedure, called arterial embolization, may be a safe way to save the spleen, but only if it can be done immediately.