The spleen is an immune system organ in the upper left portion of your abdomen. Its location means it is prone to injury after blunt force trauma, such as after a car accident. A severe spleen injury can be life threatening because you may experience significant blood loss.

In this article, we’ll discuss symptoms to look for that may indicate a ruptured spleen. We’ll also review possible causes, how doctors check for a ruptured spleen, and some treatment options.

Symptoms of a ruptured spleen depend on how damaged the spleen is. They may include:

  • pain across your abdomen
  • tenderness in the upper left portion of your abdomen
  • low blood pressure
  • Kehr’s sign, which is pain that radiates upward to the left shoulder
  • confusion or changes in your mental state
  • blurred vision
  • fast heart rate
  • paler skin than usual
  • weakness
  • intolerance for cold

About 20% of people with a spleen injury also have left lower rib fractures. If you have such a fracture, you may also have a ruptured spleen, even if you don’t have any other symptoms.

symptoms of a ruptured spleen throughout the bodyShare on Pinterest
Illustrated by Jason Hoffman

Children tend to have more pliable ribs. That means they won’t always experience a rib fracture from a traumatic injury. But they may still have an underlying spleen injury.

Most children with a spleen injury will have pain in the upper left side of their abdomen. They’re also likely to have pain in their left shoulder.

Some symptoms may suggest that there is internal bleeding. These include:

  • paler skin than usual
  • weak pulse
  • lightheadedness

Doctors will typically manage splenic injuries in children without operating. A 2022 study of 33 hospitals found that only about 2.8% of children with spleen injuries from 2010 to 2019 had surgery. Children can have a greater risk of severe infections after surgery. Doctors will usually try to be as cautious in their treatment approach as possible.

A ruptured spleen is a medical emergency

A ruptured spleen can result in significant blood loss that can lead to death without treatment. If you suspect you have a ruptured spleen, call 911 or local emergency services to get immediate help.

The spleen can rupture due to traumatic injuries or spontaneous rupture. The latter is much less common.

Traumatic injuries

The most common traumatic cause for splenic rupture is a motor vehicle accident. Other common causes include direct trauma, such as a blow to the abdomen, or a fall. Doctors usually divide traumatic spleen injuries into the following three categories:

  • penetrative trauma, such as a gunshot wound or stabbing to the abdomen
  • blunt trauma, such as a blow to the upper left abdomen from a steering wheel
  • indirect trauma, such as an accidental tear in the splenic cover after a colonoscopy

Spontaneous rupture

While most cases of splenic rupture are due to traumatic injury, it is possible for the spleen to rupture spontaneously. In about 93% of spontaneous rupture cases, the person has an underlying condition that causes an enlarged spleen.

There are many potential causes for spontaneous splenic rupture. Some of the most common include:

Some case reports even identify sneezing as a cause of splenic rupture. But this is extremely rare.

Before diagnosing a ruptured spleen, a doctor will first consider your injuries and symptoms. If your symptoms suggest a high likelihood of splenic rupture, they may order imaging tests.

Some imaging techniques can help a doctor view your spleen more clearly to confirm a diagnosis. These include:

  • Focused assessment with sonography for trauma (FAST): A FAST examination involves using ultrasound on key areas of your chest and abdomen to identify blood around the spleen. The presence of blood would suggest a rupture. But doctors can’t identify all aspects of splenic injury with this quick, bedside examination.
  • CT scan: A CT scan allows a doctor to identify injuries to the spleen and other surrounding organs.

While CT scans can be more sensitive to detecting splenic injuries, it can take a long time to obtain a CT scan. If you have symptoms of severe injury and bleeding, your doctor will usually recommend rapid, lifesaving interventions, since a ruptured spleen is a medical emergency.

Grades of spleen injuries

There are various degrees of spleen injuries. Treatment often depends on how severe the injury is.

The American Association for the Surgery of Trauma classifies spleen injuries from grades 1 to 5, with 5 being the most severe. There are many factors doctors consider when grading a spleen injury. Here is a very basic generalization:

  • Grade 1: A pool of clotted blood sits beneath the cover of the spleen. It covers about 10% of the spleen’s surface area. There’s a tear in the splenic cover less than 1 centimeter (cm) deep.
  • Grade 2: The clotted blood covers up to half of the surface area under the splenic cover. The tear is between 1 and 5 cm deep.
  • Grade 3: The clotted blood covers more than half of the surface area under the splenic cover. The tear is larger than 5 cm or extends into the deeper tissue of the spleen.
  • Grade 4: Some of the blood vessels that lead to the spleen tear. About 25% of the blood supply to your spleen cuts off.
  • Grade 5: Your spleen shatters. The blood vessels have damage that prevents your spleen from getting blood.
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Treatment for a ruptured spleen depends on numerous factors. The first is how stable your blood flow is. If you need more than two units of blood or show signs that you are still bleeding, such as low blood pressure, you will likely need surgery.

Surgery for a ruptured spleen can involve one of two approaches.

The first approach is a splenectomy, which is an operation to remove your spleen. The second approach is a splenic embolization, which involves a procedure to limit blood supply to your spleen via the splenic artery. The procedure reduces the pressure in your spleen, which can limit your blood loss while your injury heals.

You can live without your spleen. But without this immune system organ, you can be at a greater risk of infections. For this reason, doctors will usually try to preserve a portion of your spleen or opt for splenic embolization.

About 10% to 40% of people with splenic injuries will need surgery. The remainder will have non-operative treatments. Non-operative management usually involves:

  • continuing to measure your vital signs to ensure you’re stable
  • ordering repeat imaging
  • checking your blood counts frequently to ensure you aren’t experiencing further bleeding

The main complication of a ruptured spleen is excessive bleeding. Blood loss from a ruptured spleen can be so significant that it results in death without treatment.

It’s also possible to develop an infection after surgery to remove your spleen. This is more common within the first 5 years.

If you experience an accident that results in symptoms of a ruptured spleen, get help immediately. A delay in treatment could lead to more serious complications or death.

The following are some frequently asked questions about spleen rupture.

When do symptoms usually start after rupturing your spleen?

Symptoms will start based on the severity of the spleen rupture. If your rupture results in significant injury, you will experience symptoms very quickly.

In rare instances, the spleen may rupture more than 48 hours after the injury occurs. This is called delayed splenic rupture.

Can a ruptured spleen heal on its own?

The spleen’s ability to heal often depends on how severe the injury is and where it is. Many people can recover without surgery.

How long does it take to recover from a ruptured spleen after surgery?

If you experience a ruptured spleen, you will likely have other injuries. Recovery after spleen surgery, plus recovering from these injuries, can affect the timing of your recovery. Your doctor will discharge you when you show signs of blood pressure stability and do not show signs of infection.

A ruptured spleen is a serious and potentially life threatening occurrence. It’s usually due to abdominal injury. Doctors attempt non-operative management when possible to avoid increasing your risk of later infection.

It’s important not to ignore abdominal symptoms and pain if you experience an accident. They could indicate a spleen rupture or laceration. Pain in your upper left abdomen and left shoulder are the most common symptoms.