Venting a spleen

Tuesday, September 23, 2008

A little hit here, a bigger one there. Still, the players get up from the field, brush themselves of and get ready for the next play. The big hits get replayed in slow motion on highlight reels. Sometimes big hits can lead to big injuries and the latest victim is Al Harris, a Green Bay defensive back who collided with one of his teammates and fractured his spleen. It’s the same type of injury that required Chris Simms’, the former Buccaneer quarterback to have emergency surgery.

Fractured, ruptured, torn all describe injuries to the spleen, the solid organ that is located in the upper left abdomen underneath the diaphragm. It has a couple of jobs. Aside from being part of the body’s immune system, it also filters and removes older and damaged red blood cells. For it to work the spleen has a rich blood supply and like any other part of the body with a wealth of blood, injury will cause a wealth of bleeding.

Normally, the spleen is protected by the left lower ribs but forces can overcome that protection. In car accidents or falls, the ribs can break and damaged the spleen or the ribs are compressible enough to flex into the spleen and then pop back to normal shape. Sometimes the spleen is injured when the trauma hits just right in the left upper abdomen just below the ribs. Falling from a bicycle may allow the handlebar to can catch the rider just under the ribs and damage the spleen.

The use of CT scan to evaluate spleen injuries has allowed patients to be watched instead of being rushed to the operating room. If the capsule of the spleen is intact and contains the bleeding within the spleen itself, or if there is just a small amount of leaked blood, observing the patient in the ICU may be the way to go. Big damage though may need big intervention. It may be having the spleen removed in the operating room or it may be having an interventional radiologist control the bleeding by clotting off some of the small blood vessels to the part of the spleen that is bleeding. Regardless, an injured spleen is an emergency and needs a surgeon to be involved, just in case surgery becomes an option.

Spleen injuries aren’t always easy to diagnose. Sometimes the injury history seems trivial and is almost forgotten. Instead of abdominal pain, the patient can complain of ache in the shoulder or back or pain with a deep breath; all signs of diaphragm inflammation (remember where the spleen sits). Patients wonder why the doc is feeling their belly when it’s their back and shoulder that hurt. CT has made a big difference allowing technology to explore inside the body instead of a surgeon, but the doctor needs to recognize the need to explore in the first place.

Both Simms and Harris continued to play after their injuries occurred. The symptoms start when enough bleeding and swelling occur to cause pain and weakness. As a pro athlete, one big hit probably feels like another and shaking it off is part of the job. In the real world, people probably shouldn’t do that. Getting checked out after car wrecks or other accidents seems like the way to go. We’re all looking to play that next season.

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