m Predisposing Factors:
A diseased spleen is more liable to rupture as in:
1- Malaria. 2- Infectious mononucleosis. 3- Typhoid fever.
FN.B: Bilharzial spleen is less liable to rupture due to tough capsule due to fibrosis.
Aetiology:
1-Closed trauma:
A- Direct trauma: to Lt hypochondrium
B- Indirect trauma: e.g. Fall from a height ® acceleration deceleration injury.
2- Open.trauma: e.g. Stab wound.
3- Spontaneous rupture: due to unnoticed trauma.
Clinical Types:
(I) Early rupture
· Fatal type. · Usual type.
(II) Delayed rupture ® " subcapsular haematoma".
Cl. Picture:
1- Fatal type: Due to avulsion of the pedicle of spleen ® Massive intraperitoneal hge ®rapid death before the pnt. reaching hospital.
2- Usual type: Due to small lacerations ® features of Int. hge. & peritoneal irritation.
a) Features of int hge: Shock; pallor, thirst & Air hunger.
On abdominal examination:
1- Free blood in peritoneum: ® shifting dullness.
2- Ballance's sign: ®Fixed dullness in Lt, side due to haematoma around the spleen.
3- Cullen's sign: ®Discolouration around umblicus appears if the patient lives 1 or 2 days after trauma without surgical interference.
b) Features of peritoneal irritation:
1- Severe pain in Lt. hypochondroum referred to the Lt shouldr " Kehr's sign".
2- Marked tenderness and rigidity in the abdomen.
3- P / R ® Marked tenderness in the peritoneum.

3- Delayed rupture:
Manifestations occurs after days or weeks due to either ® subcapsular haematoma ® may rupture or ® small tear closed with bl. clot ® disloged.
Investigations:
1- Ultrasonography: Define the haemotoma & tears and free blood in the peritoneum.
2- Diagnostic peritoneal lavage (DPL): Either closed or open peritoneal cannulation and irrigation with 1000 cc saline. Aspiration of saline & microscopic examination of the aspirated fluid can diagnose mild intra-abdominal injuries.
3- Diagnostic laparoscopy in doubtful cases.
Treatment:
While resuscitation, immediate exploration once diagnosis is made.
1- Splenectomy, peritoneal lavage, searsh for other injuries & put a drain.
2- In children with small tear some surgeon prefer to do partial splenectomy to preserve immunological function of the spleen.
3- In children with damaged spleen, autotransplantation of the spleen. This can be performed by wrabbing of 1x1 cm of splenic tissue inside omental cover.
SOURCE: DR. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (www.vsegypt.org) &Medical Educational web (www.meduweb.com)
Not to be reproduced without permission of Vascular Society of Egypt