Spleen injury

　　The spleen is one of the abdominal organs most susceptible to injury, and the incidence of splenic injury in various abdominal traumas can reach 40% - 50%. Splenic rupture caused by traffic accidents is the leading cause (accounting for about 50% - 60%), followed by falls, blows, falls, and knife wounds. The clinical manifestations are complex, requiring timely diagnosis and appropriate treatment. Otherwise, it may threaten life, with a mortality rate of 3% - 23%. The mortality rate can reach as high as 70% in cases with splenic pedicle or major vascular injury. Then, what are the causes of splenic injury? The following experts introduce the causes of splenic injury.

　　1. Traumatic splenic injury: Depending on the cause of injury, traumatic splenic injury can be divided into two types: open splenic injury and closed splenic injury. ① Open splenic injury: Often caused by lacerations, bullet贯通, and explosions. It often involves injuries to other organs, especially common in wartime. ② Closed splenic injury: Also known as blunt splenic injury, it often occurs in traffic accidents, followed by falls, left chest injury, and left upper abdominal contusions. Children are mainly affected by abdominal trauma.

　　2. Spontaneous splenic injury: It is divided into spontaneous rupture of pathological spleen and normal spleen. The former is more common, such as splenic involvement in malaria or congestive splenomegaly. The pre-existing diseases of the spleen mentioned above can be considered as the internal cause of spontaneous splenic injury, while minor injuries, even daily activities, may be triggers for spontaneous splenic injury. Conditions such as fever, fatigue, cough, vomiting, sexual intercourse, sudden turning, and childbirth may trigger spontaneous splenic injury.

　　3. Iatrogenic splenic injury: It can be categorized into the following causes, ① Injury during surgery: It is the most common cause of iatrogenic splenic injury, often occurring during surgeries near the spleen, such as stomach, colon, and kidney surgeries. ② Invasive procedures and treatments: Such as splenic biopsy with needle puncture, splenic portal vein angiography through splenic puncture, and splenic artery embolization. These procedures are more likely to cause splenic injury due to the pathological changes such as splenic congestion and enlargement, and poor coagulation mechanism in the spleen of these patients.

　　The main complications of splenic injury include intra-abdominal hemorrhage, secondary splenic cysts, splenic abscess, and complications related to surgery, such as postoperative hemorrhage, abdominal infection, lung infection, pancreatic fistula, splenic fever, and severe infections after splenectomy.

　　1. Secondary splenic cysts: They are tumor-like cystic lesions of splenic tissue, which can be clinically divided into parasitic cysts and non-parasitic cysts. Parasitic splenic cysts are common in middle-aged and young adults, while non-parasitic splenic cysts are more common in adolescents.

　　2. Spleen abscess: It is a rare disease. The spleen is a high-selective filter and phagocytic activity center in the blood, with immune ability to resist local infection and is generally not prone to infection. The clinical manifestations are often atypical and lack specific symptoms. Most patients have symptoms such as fever and abdominal pain. Early diagnosis is difficult, and it is easy to be misdiagnosed as sepsis or septicemia. Late stages may appear various serious complications.

　　For spleen injury, the clinical manifestations of splenic rupture are characterized by internal bleeding and the stimulation of blood on the peritoneum, which is often closely related to the amount and speed of bleeding. And for those with large and rapid bleeding, hypovolemic shock appears quickly, which is very serious; the result is very dangerous. While for those with small and slow bleeding, the symptoms are mild, with only slight pain in the upper left abdomen without other obvious signs, making it difficult to diagnose.

　　With the passage of time, the amount of bleeding increases, and the signs of pre-shock appear, followed by shock. Abdominal pain occurs due to the stimulation of blood on the peritoneum, originating in the upper left abdomen and gradually involving the entire abdomen, but still most obvious in the upper left abdomen. At the same time, there is abdominal tenderness, rebound pain, and muscle tension in the abdomen. Sometimes, due to the stimulation of the left diaphragm, there is referred pain in the left shoulder, which worsens with deep breathing, this is known as the Kehr sign.

　　The spleen is one of the abdominal organs most susceptible to injury, with traffic accidents being the leading cause of spleen rupture, followed by falls, blows, bruises, and knife wounds, etc. The clinical manifestations of spleen injury are complex, requiring timely diagnosis and proper treatment. Otherwise, it may be life-threatening, with a mortality rate of 3% - 23%. The mortality rate for those with splenic pedicle or major vascular injury can be as high as 70%. So, how can spleen injury be prevented? The following experts introduce the measures for preventing spleen injury.

　　1. Maintain a peaceful mood, avoid emotional excitement, and rest in bed as advised by the doctor.

　　2. After discharge, if there are symptoms such as vomiting, abdominal distension, abdominal pain, and fever, please come to the hospital for consultation at any time.

　　3. Pay attention to rest and diet, refrain from smoking and drinking, eat light and easily digestible foods, and avoid overeating.

　　4. For those with constipation, pay attention to adjusting diet and keeping the bowels regular. If ineffective, appropriate oral laxatives can be taken to avoid straining during defecation.

　　The spleen is one of the abdominal organs most susceptible to injury, with an incidence of spleen injury in various abdominal traumas reaching up to 40% - 50%. Traffic accidents are the leading cause of spleen rupture, followed by falls, blows, bruises, and knife wounds, etc. Treatment shows that in open abdominal injuries, spleen rupture accounts for about 10%, while in closed abdominal injuries, spleen rupture accounts for about 20% - 40%. Spleen rupture is a severe condition, often accompanied by injuries to other organs, with complex clinical manifestations. Timely diagnosis and proper treatment are required, otherwise it may be life-threatening, with a mortality rate of 3% - 23%. The mortality rate for those with splenic pedicle or major vascular injury can be as high as 70%. So, what laboratory tests are needed to diagnose spleen injury? The following experts introduce the examination items for spleen injury.

　　1. Laboratory examination: When there is bleeding from splenic rupture, the blood routine shows a progressive decrease in red blood cell count and hemoglobin, and the white blood cell count can slightly increase. Other examinations such as electrolytes, coagulation function, blood type, amylase, etc., although not specific for diagnosis, should also be routine examinations for abdominal trauma, helping to differentiate from other associated injuries and judge the condition.

　　2. Diagnostic abdominal puncture and lavage: It is an invasive examination with a positive rate of over 90%, and it is of great help in diagnosing whether there is organ injury in the abdomen and what kind of organ injury it is. If the fluid extracted is fresh, unclotted blood or bloody fluid, it proves that there is bleeding in the abdominal viscera. If the fluid is turbid, it is a characteristic of gastrointestinal rupture.

　　3. Ultrasound examination: It is the preferred method, with advantages of non-invasive, economical, and quick, and can show broken spleen, large subcapsular hematoma of the spleen, and blood in the abdomen. It helps to observe the degree and classification of spleen injury and can help dynamically observe the development of the condition.

　　4. X-ray examination: It helps to judge the condition of abdominal bleeding and whether there is injury to hollow organs such as the gastrointestinal tract.

　　5. CT examination can clearly show the shape and anatomical structure of the spleen, and has a high accuracy in diagnosing实质裂伤 or subcapsular hematoma of the spleen.

　　6. Radionuclide scanning: 99mTc colloidal sulfur scanning or gamma photography and other techniques can be used to diagnose spleen injury, and the method is safe.

　　7. Selective splenic arteriography: This is an invasive examination with complex operation and certain risks. However, it has a high accuracy in diagnosing splenic rupture and can show the location of the injured splenic artery and substance. It is only used for closed injuries with stable conditions and other methods failed to make a clear diagnosis.

　　8. Magnetic resonance imaging: Generally not used for emergency diagnosis, limited to patients with stable conditions and difficult diagnosis. It has advantages in checking hemorrhage and hematoma.

　　9. Laparoscopic examination: It can be adopted for those with difficult diagnosis and unclear indications for laparotomy, and can also be used as a treatment method at the same time.

　　10. Diagnostic laparotomy: In a few cases, it is not possible to exclude extraperitoneal injury, nor can special examinations be performed, and the condition has a tendency to gradually worsen. It is adopted for clear diagnosis and timely treatment.

　　Patients with spleen injury should eat foods with warm and sweet and spicy flavors, which have the effects of invigorating the spleen and Qi, warming the intestines and stomach, and removing coldness, such as glutinous rice, lamb, chicken, beef stomach, pork stomach, catfish, grass carp, lychee, chili, chive, fennel, rapeseed, cinnamon, dried ginger, ginger, Sichuan pepper, black pepper, fennel, white cardamom, brown sugar, etc.

　　Patients with spleen injury should avoid eating foods with cold properties and easy to damage the spleen and stomach yang, such as buckwheat, millet, mung beans, tofu, spinach, amaranth, eggplant, black fungus, chive, lettuce, winter melon, celery, amaranth, lotus root, cucumber, bitter melon, watermelon, persimmon, banana, loquat, pear, peach, etc.

　　The spleen is one of the abdominal organs most susceptible to injury. The causes of splenic rupture include falls, blows, falls, and knife injuries. Splenic injury can be life-threatening, with a mortality rate of 3% to 23%. The mortality rate can reach as high as 70% in cases with splenic pedicle or major vascular injury. So, how to treat splenic injury? The following experts introduce the treatment methods of splenic injury.

　　1. Local coagulation hemostasis: There are many coagulation methods, such as laser, infrared rays, high-temperature air, etc. Coagulation methods can be used to treat the wound first, and then apply biological materials locally, which has a good effect.

　　2. Local adhesive: Mainly applied to grade I splenic injury, and can also be used for mild bleeding in splenic repair surgery and partial splenectomy.

　　3. Total splenectomy: China has adopted this extensively, although it has been recognized that post-splenectomy can bring a series of adverse consequences, this classic surgical method still has irreplaceable advantages. It has the characteristics of rapid and thorough hemostasis, wide indications, and is still the only choice in some special situations.

　　4. Splenic rupture suture repair: It belongs to splenic-preserving surgery, with relatively simple technology. When conditions are available and the surgical indications are met, it should be the first choice.

　　5. Partial splenectomy: Applicable to grade III splenic rupture, with localized injury, and it is difficult to stop bleeding or the damaged spleen tissue has lost vitality. After partial splenectomy, more than half of the spleen parenchyma can be preserved.

　　6. Splenic artery ligation: Splenic artery ligation does not necessarily cause the necrosis of the spleen. Currently, this surgical method is mainly applied in the treatment of splenic injury and bleeding, and has a good effect when used in combination with other splenic-preserving surgeries. Its characteristic is that it retains the complete structure of the spleen. By ligating the main trunk of the splenic artery, it reduces the blood flow of the spleen, while also reducing the volume and tension of the spleen, which is conducive to suturing and repairing the spleen.

　　7. Total splenectomy + autologous spleen tissue strip omental sac implantation: Since the 1980s, it has been generally considered as an effective method to compensate for spleen function after total splenectomy. It meets the needs of quickly controlling bleeding after splenectomy to ensure patient safety and can safely and reliably compensate for spleen function.

　　8. Autologous spleen tissue graft with vascular pedicle: This surgery is relatively difficult, but the surgical outcome is reliable, and the recovery of spleen function is quick after the operation. Under the conditions of indications and technical requirements, it is a good treatment measure.