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Roentgen Diagnosis of Lacerated Spleen

1942; Radiological Society of North America; Volume: 39; Issue: 6 Linguagem: Inglês

10.1148/39.6.707

1527-1315

Leon Solis-Cohen, Samuel A. Levine,

Abdominal Trauma and Injuries

In civilian life traumatic injury of an intra-abdominal organ is by no means a rarity, particularly since the advent of the automobile and the mechanization of industry. In perforations of a hollow viscus the radiologist has been of distinct aid to the clinician and surgeon in demonstrating free air beneath the diaphragm. In lacerations of the liver and spleen he has been less helpful. At the present time, under the conditions of global war, careful evaluation of roentgen films, with the object of diagnosing hepatic or splenic injuries, is of special importance. Blast injuries due to bombs may cause rupture of solid or hollow viscera without external evidence. The differentiation of intraperitoneal from extraperitoneal injury may not only be baffling to the diagnostician, but is often of great concern to the surgeon in his concrete approach to a specific case. We shall attempt in this paper to record and analyze the x-ray evidence of splenic lacerations. Anatomy of Spleen The spleen is a soft, highly elastic, contractile organ of purplish color, situated in the upper left posterior part of the abdominal cavity, partly in the epigastrium, mainly in the left hypochondrium. It is molded by the diaphragm, kidney, stomach, and colon. Its dimensions vary widely, but average 12 × 7 × 4 cm. (weight 200 gm.). The shape of the spleen is modified by the relaxation, distortion, or contraction of the neighboring organs. It is also subject to substantial alteration with physiologic variations. When the stomach is distended and the colon contracted, the spleen has the shape of a segment of an orange; when the stomach is contracted and the colon distended, it has the form of an irregular tetrahedron. In the recumbent position the long axis of the spleen corresponds in direction with the posterior part of the tenth rib. The gastric surface of the spleen is deeply concave, molded by the stomach. It is interrupted by an irregular slit, the hilum, through which the splenic vessels course. The spleen is entirely covered by peritoneum and is anchored by two peritoneal folds—the lienorenal and gastrolienal ligaments. Diagnosis of Laceration The symptoms of a lacerated spleen are those of intra-abdominal hemorrhage. Pain may radiate to the left scapula; there may be a tender indefinite mass, rigidity of the overlying muscles, shifting dullness, and shock. Hemorrhage may be violent, resulting in early death; it may be progressive, allowing the patient to walk perhaps a half a mile, with exsanguination following within forty-eight hours, or it may be of the delayed type, characterized by repeated bleeding, usually with violent pain on exertion, at intervals of several days. Delayed splenic hemorrhage presents a serious catastrophe, which must be recognized promptly if the patient is to survive.