Ruptured spleen: symptoms, treatment and recovery

The spleen sits in the upper left of the abdomen, tucked under the lower ribs. The NHS says it is an important part of the immune system, although you can survive without it because the liver can take over many of its functions.

It has three main jobs: fighting germs in the blood, since it contains infection-fighting white blood cells, controlling the level of blood cells, and filtering the blood to remove old or damaged red blood cells. Because it is rich in blood, an injury can bleed heavily.

South Tees Hospitals' trauma leaflet adds that the spleen sits under the lower ribs and the left side of the diaphragm, which explains why a blow to the left side of the lower chest can reach it.

The NHS says the spleen can be damaged or burst after an injury, such as a blow to the abdomen, a car accident, a sporting accident or broken ribs. South Tees describes direct blows, impact with an object and sudden deceleration, such as a road accident or fall from a height.

Both blunt and penetrating injuries to the stomach or left lower chest can injure the spleen. The severity varies, and some abdominal injuries are minor enough to be managed by observation alone, while more serious ones need an operation.

An enlarged spleen is at greater risk. The NHS notes it can become swollen after infection, injury or conditions such as cirrhosis, leukaemia or rheumatoid arthritis, and that you need to avoid contact sports for a while because the risk of rupture is higher.

The NHS describes pain behind the left ribs with tenderness when the area is touched, and dizziness with a rapid heart rate. The last two are signs of low blood pressure caused by blood loss. A painful spleen is usually felt behind the left ribs.

Timing is important. The NHS says rupture can happen straight away or it may happen weeks after the injury. Anyone with left upper abdominal pain after an accident, a fall or broken ribs should get checked rather than assume the pain will pass.

The NHS advice is to go straight to A&E if you think you have ruptured or damaged your spleen.

Hospital care depends on the severity and on how stable the person is. South Tees describes three approaches. Non-operative management means admission with close monitoring of blood pressure, heart rate and regular blood tests to look for signs of bleeding.

Embolisation is performed in interventional radiology. A wire is inserted through the groin under X-ray guidance so that the bleeding area can be sealed with specialist coils. If injury is severe, an operation to remove the whole spleen, a splenectomy, is required.

Hospital guidance for clinicians from south-east Scotland says non-operative management may be considered for any grade of injury. It lists operation as appropriate where the person is unstable despite resuscitation or has ongoing bleeding after radiological treatment, and recommends observation for a minimum of 48 to 72 hours for higher-grade injuries.

South Tees lists complications of non-operative management: recurrent bleeding, a collection of blood, abscess, cyst, fluid in the chest, chest infection and blood clots in the veins of the legs or lungs. The risk rises in older people, those who are overweight and those with existing medical conditions.

After keyhole spleen removal the NHS says it is normal to be sore and bruised, and recovery usually takes a few weeks. Breathing and leg exercises reduce the risk of clots and chest infection, and blood-thinning injections may be given for around 1 to 2 weeks.

The South Tees leaflet advises not driving for at least 4 to 6 weeks and avoiding high-impact activity during recovery. Return to the emergency department if you develop new or worsening abdominal pain, dizziness, a rapid heart rate, vomiting, collapse, or fever and shivering.

Other organs, mainly the liver, take over many of the spleen's functions, so most infections can still be handled. The NHS says there is a small risk that a serious infection develops quickly, and that this risk lasts for life. Young children have a higher risk than adults, and so do people with sickle cell anaemia, coeliac disease or immune problems.

The precautions are practical. The NHS advises being up to date with routine vaccines, plus pneumococcal vaccination with a booster every 5 years, a yearly flu vaccine, MenACWY and MenB. Low-dose antibiotics are recommended for at least 2 years and in many cases for life, especially in under-18s, over-50s and those with weak immunity.

See a GP as soon as possible for signs of infection, including high temperature, sore throat, cough, severe headache, headache with drowsiness or a rash, or abdominal pain. Tell all healthcare staff including your dentist, carry medical ID or a splenectomy card, take care with animal and tick bites, and seek advice before travel, as the NHS notes a greater risk of severe malaria.