My Spleen hurts

Most people have no idea what their spleen does and even less of an idea where their spleen is. Trauma surgeons do. A common injury for victims of blunt abdominal trauma happens to be an injured spleen aka splenic laceration. We had more than our share of injured spleens this month. Some patients with splenic injuries are able to avoid surgery, but others continue to bleed into their abdomens and ultimately require a splenectomy.

Last week a 23 yr old kid came to the emergency room after crashing on his snowboard earlier in the day. He complained of abdominal pain, so we scanned his belly and saw a grade IV splenic laceration with a moderate to large amount of blood in his abdominal cavity. His vital signs were stable and his blood level had not dropped too far, so we decided to admit him to the surgical intensive care unit (SICU) to monitor him in hopes that we could avoid having to operate on him.

I checked on the young man a couple times during the evening and night, the last of which was at 1 AM. He was resting comfortably and his pulse was in a normal range (80 per minute). His blood level had not dropped much and he said his pain was improving. I decided to go to the call room to catch some zzzzzzzzz's.

At 3 AM I got a page from one of the SICU residents telling me I needed to get there ASAP. I jumped out of my uncomfortable bed and ran to the SICU where I found our patient to be very unstable. His pulse was now in the 160's per hour and his blood pressure had dropped to worrisome levels as had his blood level. I pushed on his abdomen and it was rigid as a board, another sign that things were heading south for us in a hurry. He told me that the pain was intolerable and he said his vision was going blurry. He began fading in and out. We quickly called his parents who live in Missouri and he was too sick to talk to his mom (you know a guy is VERY sick when he won't even say hi to his mom on the phone).

We rushed him to the operating room where we quickly made an incision from his sternum to his belly button. His abdomen was filled with blood and his spleen was in a million little pieces. We quickly removed his spleen and suctioned the blood from his belly. He had a total of 3 liters of blood in his abdomen which is impressive given that the average adult has a total of 5 liters of blood in their entire body.

After surgery the kid did great. We truly saved his life. He would have died in a matter of minutes had we not been there to rush him to the operating room. If he had decided to go home after his snowboard accident and tried to tough it out instead of coming to the hospital, he would have died at home that night.