Abdominal Injury : Ruptured SpleenThe spleen is the most commonly injured organ in instances of blunt trauma to the abdomen (motor vehicle accidents). The spleen, is a very vascular organ and can bleed profusely if it is injured. The location of the spleen is in the left upper quadrant of the abdomen, beneath the rib cage. Injury resulting from a blunt force to this area (kick, fall, seatbelt, etc.) could cause damage to the spleen. Left lower chest injuries, particularly those which fracture ribs 8, 9, or 10, can also result in rupture of the spleen. Common symptoms of spleen injury include: persistent left upper quadrant abdominal pain, nausea or vomiting, lightheadedness upon standing, or fainting. Signs and symptoms of hemorrhagic shock are common. The left upper quadrant abdominal pain may increase in severity with deep breathing, and can be accompanied by pain in the left shoulder ("Kerr's sign"). In the more serious cases, patients often have a rapid pulse (greater than 100 beats per minute) and low blood pressure. More uncommonly, the patient will claim very little discomfort at the time of the injury, but will develop increasing severity of left upper quadrant abdominal pain within 4-6 hours. Evaluation will include physical examination to check blood pressure and pulse. The finding of tenderness to palpation in the left upper quadrant suggests spleen injury. Complete blood count will be performed to help assess blood loss. CT-scanning of the abdomen can reveal splenic injuries with an x-ray. Unstable patients, with classic symptoms and findings often go directly to surgery for exploration and repair. Peritoneal lavage is helpful in determining need for surgical intervention. Hospitalization with close observation is necessary for suspected splenic injuries. Children with minor spleen injuries can often be managed nonsurgically. Due to the spleen's role in fighting infection, the spleen is removed only in cases where significant trauma has occurred. The General Surgeon is the expert in the management of this problem.
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