Anatomy Thorax Abdomen · Year 1 · from Anatomy Thorax Abdomen
Case 2: Splenic Rupture Following Blunt Trauma
Clinical Presentation
A 28-year-old female presents to the emergency department after a motor vehicle collision in which she was a restrained driver whose vehicle was struck on the left side. She complains of left upper quadrant and left shoulder pain. She is alert and oriented but appears anxious.
On examination, blood pressure is 100/70 mmHg with heart rate of 110 beats per minute that increases to 125 on standing. The abdomen is tender in the left upper quadrant with guarding. FAST examination (Focused Assessment with Sonography in Trauma) reveals free fluid in the splenorenal recess and Morrison's pouch. CT scan with contrast demonstrates a grade III splenic laceration with active extravasation and moderate hemoperitoneum. Due to her hemodynamic instability despite resuscitation, she undergoes emergent splenectomy. She receives appropriate post-splenectomy vaccinations before discharge.
Key Anatomical Points
- The spleen lies in the left upper quadrant protected by ribs 9-11 in a posterolateral position
- It is connected to the stomach by the gastrosplenic ligament (containing short gastric and left gastroepiploic vessels)
- The splenorenal ligament connects the spleen to the left kidney and contains the splenic vessels and tail of the pancreas
- Kehr sign (left shoulder pain) occurs from diaphragmatic irritation by blood - the phrenic nerve (C3-5) shares dermatomes with the shoulder
Key Learning Points
- The spleen follows the "1-3-5-7-9-11 rule": 1x3x5 inches, 7 ounces, ribs 9-11
- The splenic artery is an end artery with no anastomoses within the spleen - branch occlusion causes segmental infarction
- Post-splenectomy patients require vaccination against encapsulated organisms (S. pneumoniae, H. influenzae, N. meningitidis)
- The spleen normally holds 30% of the body's platelet pool