The spleen is a soft, highly vascular organ located in the left upper quadrant of the abdomen. It is part of both the lymphatic and circulatory systems, playing a vital role in filtering blood, supporting the immune system, and recycling old red blood cells.
The spleen helps remove damaged blood cells and platelets while producing and storing white blood cells (lymphocytes) that fight infection. It also acts as a blood reservoir, releasing stored blood during hemorrhage or physical stress.
MedBound Times connected with Dr. Bipin Jha about Spleen injuries. Dr. Bipin Jha is a Consultant in Robotic, Laparoscopic, Laser and Endoscopic Colorectal General and Emergency Surgery currently working as a consultant in multiple hospitals in Patna (Savera Cancer & Multispeciality Hospital and Asian city hospital).
As Dr Bipin Jha explains, the spleen is a highly vascular organ located beneath the 9th, 10th and 11th ribs on the left side. Splenic injury may occur through two primary mechanisms: penetrating trauma (for example knife or glass wounds) and blunt abdominal trauma (for example rib fractures or deceleration injuries).
The spleen is the second most commonly injured abdominal solid organ after the liver in blunt trauma.
Blunt trauma may include rib fractures whose sharp tips lacerate the spleen and cause injury. A high-speed deceleration in a vehicle (such as a vehicle crash) where sudden movement causes internal shear forces can also result in spleen injuries. Dr Jha said a significant impact force is required for adult ribs to injure the spleen. An already enlarged spleen (such as in lymphoma or other disease) presents increased risk of rupture.
When the spleen is lacerated or ruptures, the patient may bleed internally. Dr Jha notes key signs of splenic rupture include thirst, sweating, restlessness, very severe pain in the left upper abdomen and possibly fainting.
Because the abdominal cavity has space for blood to collect, the abdomen may not appear very distended. The patient may lose 500 ml to 1 litre of blood, become hypotensive, tachycardic and show elevated respiratory rate. Bruising may be present externally.
The classification of splenic injury is commonly done using the American Association for the Surgery of Trauma (AAST) splenic injury scale. The scale is based on imaging findings and depth of laceration or hematoma. According to radiopaedia and other sources:
Grade I: Subcapsular hematoma < 10% surface area or laceration < 1 cm depth.
Grade II: Subcapsular hematoma 10–50% surface area or intraparenchymal hematoma < 5 cm, or laceration 1–3 cm depth.
Grade III: Subcapsular hematoma > 50% or ruptured hematoma, or laceration > 3 cm depth.
Grade IV: Involves segmental or hilar vessels with > 25% devascularisation.
Grade V: Shattered spleen or major devascularisation and bleeding into abdominal cavity.
Dr Jha notes that Grade 4 cases “most of the time require splenectomy” and Grade 5 injuries “would definitely require splenectomy”.
Initial management begins with patient stabilisation: oxygen, intravenous fluids and analgesics. As Dr Jha described:
If the patient is stable, a CT scan of abdomen is done for grading.
If unstable, a Focused Assessment with Sonography for Trauma (FAST) scan may detect free fluid and trigger urgent surgery.
For Grade 1 to Grade 3 injuries in stable patients, conservative management (non-operative) is standard: close monitoring in High-Dependency Unit (HDU) for 48 hours, with vitals and haemoglobin checks.
At Grade 3 if the patient becomes unstable, a CT angiogram with possible radiological intervention (embolisation of bleeding point) may be done.
At Grade 4, splenectomy is commonly required, though select high- level centres may attempt spleen preservation. Grade 5 injuries usually require splenectomy.
These management steps align with published guidelines showing non-operative management (NOM) success rates over 80-90% in stable patients.
Even after initial successful management, there is a risk of delayed rupture (usually within two weeks), especially in Grade 2 or Grade 3 cases. Dr Jha emphasises that patients and families should be warned: symptoms may include loss of consciousness, dizziness or sudden pain.
If splenectomy is performed, patients require vaccinations (meningococcal, pneumococcal, Haemophilus) and may need prophylactic antibiotics (in some cases lifelong or for 5 years in adults, 2 years in children).
Other complications include splenic abscess (infection of retained clot) and risk of opportunistic infections due to loss of splenic immune function. After recovery and discharge from the observation period, patients typically do not require further splenic-specific surveillance if stable.
Splenic injuries require prompt diagnosis, correct grading and appropriate management choice between conservative monitoring and operative intervention. According to Dr. Bipin Jha, with modern trauma care and imaging, many patients can be managed without surgery, preserving spleen function and minimising long-term immune risk.
Değirmencioğlu, G., et al. 2025. “Splenic Lacerations: A Retrospective Analysis of …” Journal of Trauma & Acute Care Surgery, PMC Pub. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12256966/.
Medhi, Abhijit, and Hussain Ahmed. 2023. “Splenic Injury in Blunt Trauma Abdomen – Study in a Tertiary Care Centre.” IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 22, no. 2 Ser. 9 (February): 22-34. https://www.iosrjournals.org/iosr-jdms/papers/Vol22-issue2/Ser-9/D2202092234.pdf.
StatPearls Publishing. “Anatomy, Abdomen and Pelvis: Spleen.” StatPearls, last updated 2024. https://www.ncbi.nlm.nih.gov/books/NBK537307/.
