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Splenic Rupture

Clinical Subject Page

Splenic Rupture

Splenic rupture is a tear or disruption of the spleen that causes internal bleeding into the abdominal cavity. It most commonly follows blunt abdominal trauma and can rapidly become life-threatening

Also called

Splenic laceration

ICD-10

S36.0

Specialty

Gastroenterology

Onset

Acute

Reviewed

July 2026

On This Page

Overview

  • Splenic rupture occurs when the splenic capsule or tissue is damaged, allowing blood to leak into the peritoneal cavity. The bleeding may occur immediately after injury or may be delayed because of rupture of a subcapsular hematoma. Patients commonly present with left upper-quadrant pain, left shoulder pain, abdominal tenderness, tachycardia, hypotension, or hemorrhagic shock

Etiology & Risk Factors

Traumatic Causes Causing Splenic Rupture

  • Road traffic accidents

  • Falls from height

  • Sports injuries

  • Direct blow to the left upper abdomen

  • Fractured left lower ribs

  • Penetrating abdominal injury

  • Crushing injury

  • Iatrogenic injury during abdominal surgery

Blunt abdominal trauma is the most common cause of splenic rupture.

Atraumatic Causes Causing Splenic Rupture

  • Infectious mononucleosis

  • Malaria

  • Hematological malignancy

  • Leukemia

  • Lymphoma

  • Myeloproliferative disorders

  • Splenic tumors

  • Severe splenomegaly

  • Inflammatory or infiltrative diseases

  • Anticoagulant therapy

  • Splenic infarction

  • Pancreatitis

  • Amyloidosis

Risk Factors for Splenic Rupture

  • Enlarged spleen

  • Contact sports

  • Recent abdominal trauma

  • Infectious mononucleosis

  • Hematological disease

  • Anticoagulant or antiplatelet use

  • Portal hypertension

  • Previous splenic disease

  • Left lower rib fractures

Pathophysiology

Splenic rupture occurs when trauma or an underlying splenic disease causes a tear in the splenic capsule and parenchyma, leading to disruption of the highly vascular splenic tissue. This results in bleeding into the spleen (subcapsular hematoma) or directly into the peritoneal cavity (hemoperitoneum). Progressive blood loss decreases circulating blood volume, reducing venous return and cardiac output, which can lead to hypotension, hemorrhagic shock, and multiorgan hypoperfusion if not treated promptly. In some cases, a subcapsular hematoma initially remains contained but later ruptures, causing delayed splenic rupture and sudden hemodynamic deterioration.

Clinical Presentation

Common Symptoms seen in Splenic Rupture

  • Sudden left upper-quadrant abdominal pain

  • Generalized abdominal pain

  • Pain radiating to the left shoulder

  • Abdominal fullness or distension

  • Dizziness

  • Weakness

  • Nausea

  • Fainting or loss of consciousness

Common Signs seen in Splenic Rupture

    • Left upper-quadrant tenderness

    • Abdominal guarding

    • Abdominal rigidity

    • Rebound tenderness

    • Tachycardia

    • Hypotension

    • Pallor

    • Cold, clammy skin

    • Reduced level of consciousness

    • Signs of hemorrhagic shock

History Taking

  • Ask about:

    • Recent fall, accident, sports injury, or abdominal trauma
    • Site and mechanism of injury
    • Time since the injury
    • Left upper-quadrant pain
    • Pain radiating to the left shoulder
    • Dizziness, fainting, or weakness
    • Abdominal swelling
    • Previous splenic enlargement
    • Recent infectious mononucleosis
    • Hematological disease or malignancy
    • Anticoagulant or antiplatelet medication

Physical Examination

Initial Assessment

Follow the trauma ABCDE approach:

  • Airway

  • Breathing

  • Circulation

  • Disability

  • Exposure

General Examination

Assess for:

  • Pallor

  • Sweating

  • Tachycardia

  • Hypotension

  • Rapid breathing

  • Confusion

  • Reduced consciousness

  • Signs of shock

Abdominal Examination

Look for:

  • Bruising or abrasions

  • Left upper-quadrant tenderness

  • Guarding

  • Rebound tenderness

  • Abdominal distension

  • Generalized peritonism

Chest and Musculoskeletal Examination

Assess for:

    • Left lower rib tenderness

    • Rib fractures

    • Left chest-wall trauma

    • Associated thoracic injuries

Investigations

Immediate Tests

  • Complete blood count

  • Serial hemoglobin and hematocrit

  • Blood group and crossmatch

  • Coagulation profile

  • Renal function and electrolytes

  • Liver function tests

  • Serum lactate

  • Arterial or venous blood gas

  • Pregnancy test when appropriate

A single normal hemoglobin level does not exclude acute internal bleeding because the level may not fall immediately after hemorrhage.

FAST Ultrasound

Focused Assessment with Sonography in Trauma may rapidly detect free fluid in the abdomen.

It is particularly useful in unstable trauma patients, but a negative scan does not completely exclude splenic injury.

Contrast-Enhanced CT Abdomen

CT is the preferred investigation in a hemodynamically stable patient. It can identify:

  • Splenic laceration

  • Hematoma

  • Active contrast extravasation

  • Hemoperitoneum

  • Vascular injury

  • Splenic pseudoaneurysm

  • Associated abdominal injuries

CT or ultrasound is commonly used to diagnose splenic injury, with CT providing greater anatomical detail in stable patients.

Other Investigations

  • Chest and pelvic imaging for associated trauma

  • Angiography when embolization is considered

  • Repeat imaging if clinical deterioration or vascular complications are suspected

  • Complete blood count

  • Serial hemoglobin and hematocrit

  • Blood group and crossmatch

  • Coagulation profile

  • Renal function and electrolytes

  • Liver function tests

  • Serum lactate

  • Arterial or venous blood gas

  • Pregnancy test when appropriate

A single normal hemoglobin level does not exclude acute internal bleeding because the level may not fall immediately after hemorrhage.

FAST Ultrasound

Focused Assessment with Sonography in Trauma may rapidly detect free fluid in the abdomen.

It is particularly useful in unstable trauma patients, but a negative scan does not completely exclude splenic injury.

Contrast-Enhanced CT Abdomen

CT is the preferred investigation in a hemodynamically stable patient. It can identify:

  • Splenic laceration

  • Hematoma

  • Active contrast extravasation

  • Hemoperitoneum

  • Vascular injury

  • Splenic pseudoaneurysm

  • Associated abdominal injuries

CT or ultrasound is commonly used to diagnose splenic injury, with CT providing greater anatomical detail in stable patients.

Other Investigations

    • Chest and pelvic imaging for associated trauma

    • Angiography when embolization is considered

    • Repeat imaging if clinical deterioration or vascular complications are suspected

Diagnosis

  • Diagnosis is based on:

    • History of trauma or underlying splenic disease
    • Symptoms and signs of internal bleeding
    • Hemodynamic assessment
    • FAST ultrasound findings
    • Contrast-enhanced CT findings
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Management

Initial Resuscitation

  • Follow the ABCDE trauma approach

  • Give supplemental oxygen when required

  • Establish large-bore intravenous access

  • Send blood for urgent testing and crossmatch

  • Begin controlled fluid and blood-product resuscitation

  • Correct coagulopathy

  • Stop or reverse anticoagulation when appropriate

  • Provide analgesia

  • Arrange urgent trauma or surgical consultation

Hemodynamically Stable Patient

Nonoperative management may be considered when:

  • Blood pressure remains stable

  • There is no generalized peritonitis

  • No other injury requires laparotomy

  • Close monitoring and urgent intervention are available

Management may include:

  • Hospital admission

  • Serial vital signs

  • Repeated abdominal examination

  • Serial hemoglobin measurement

  • Blood transfusion when required

  • Activity restriction

  • Repeat imaging when clinically indicated

  • Splenic artery embolization for active bleeding or selected vascular injuries

Observation and angiographic embolization are important components of spleen-preserving management in appropriate stable patients.

Hemodynamically Unstable Patient

Urgent operative management is generally required when there is:

  • Persistent hypotension despite resuscitation

  • Ongoing major hemorrhage

  • Generalized peritonitis

  • Failed nonoperative management

  • Severe associated abdominal injury

Possible procedures include:

    • Splenic repair

    • Partial splenectomy

    • Total splenectomy

 

Patients who undergo splenectomy require:

  • Pneumococcal vaccination
  • Meningococcal vaccination
  • Haemophilus influenzae type b vaccination
  • Education about the risk of overwhelming postsplenectomy infection
  • Urgent medical assessment for fever
  • Antibiotic prophylaxis according to age and local guidelines
  • Medical alert identification where available
    •  

Complications

  • Massive internal hemorrhage
  • Hemorrhagic shock
  • Delayed splenic rupture
  • Rebleeding
  • Splenic artery pseudoaneurysm
  • Splenic abscess
  • Infection
  • Multiple-organ failure
  • Death
  • Overwhelming postsplenectomy infection after splenectomy

Prognosis

  • The prognosis depends on:

    • Severity of splenic injury
    • Amount of blood loss
    • Speed of diagnosis and treatment
    • Hemodynamic stability
    • Associated injuries
    • Patient age and comorbidities

    Small or moderate injuries in stable patients often heal successfully without surgery. Severe rupture with uncontrolled hemorrhage carries a significant risk of shock and death without immediate treatment.

Key Points / Clinical Pearls

  • Splenic rupture is a tear of the spleen that can cause life-threatening internal bleeding.
  • Blunt abdominal trauma is the most common cause.
  • Left upper-quadrant pain and left shoulder-tip pain are important clinical clues.
  • Tachycardia and hypotension may indicate major blood loss.
  • FAST is useful for rapid assessment, while contrast-enhanced CT is preferred in stable patients.
  • Stable patients may be managed with observation or splenic artery embolization.
  • Unstable patients usually require urgent surgery.
  • Delayed rupture can occur even after initially mild symptoms.
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