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2. AetiologyRoad traffic accidentsFall from heights left lower chest or left upper quadrant of abdoment hitting some objectAssault by blunt or sharp instrimentsMinor injuries like fall without direct trauma to the spleen if it is diseased or enlarged infectious mononucleosis or malariaFract
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1. 1 Splenic Injuries
2. 2 Aetiology
Road traffic accidents
Fall from heights – left lower chest or left upper quadrant of abdoment hitting some object
Assault by blunt or sharp instriments
Minor injuries like fall without direct trauma to the spleen if it is diseased or enlarged – infectious mononucleosis or malaria
Fractures of the overlying ribs
3. 3 Cases of ruptured spleen may be divided into three groups:-
1. Rapid Death from massive haemorrhage
2. Initial shock – recovery – signs of bleeding upper abdominal guarding local bruising and abdominal distension
3. The delayed case
Initial signs pass off and the concern about a serious intra-abdominal bleed is postponed - late rupture after 2 to 3 days
4. 4 Clinical Features
History of injury
Pain left side of chest or left upper abdomen
Faintness
bruising
Pain referred to the left shoulder known as Kehr’s sign. The sign can be demonstrated 15 minutes after elevation of the foot of the bed – blood under diaphragm.
Shifting dullness – PR – fullness in the pelvis
5. 5 Investigations USGM
CAT scan
Hb estimation
Blood Grouping and Rh typing
Reserve four units of blood
Monitor the pulse – if the pulse shoots up by more than 20/minute alert the doctor
Monitor the BP
USGM can be repeated as many times as necessary for monitoring purpose
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11. 11 Treatment of Rupture of Spleen Spleen preservation especially in countries where malaria is prevalent
Vicryl mesh bag and tightening to stop bleeding – especially for children – if by compression bleeding can be stopped.
Splenectomy in cases where it is unavoidable.
( long term prophylaxis against streptococcal infections will be needed)
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