Knowledge
Medical Insight: Polodoc
Dr.med. Andreas Krüger is a Swiss board orthopaedic and trauma surgeon in Zurich, who specialises in knee and shoulder surgery. Andi is a second generation of tournament doctors for equine sports, known as Polodoc since 2013 and affiliated with Polo Park Zurich
Gut Punch The silent killer
A direct blow to the stomach area can happen fast – mostly without any harm. But with rising blunt forces to these soft and elastic intestinal structures the danger of bleeding increases dramatically. Since the 1970s the aggressive operative approach to all forms of abdominal trauma was the golden standard until the establishment of formal trauma centres. Due to the fact that the spleen is a solid organ it is the most often injured organ in blunt trauma. In former times the Splenectomy was the only satisfactory treatment for this injury. Participation in sports that involve the potential for contact or collision needs to be carefully assessed in high velocity accidents.
Diagnostics on & off the field
First responders or in the absence of professional caretakers a teammate can palpate the abdomen. Symptoms of a lacerated or ruptured spleen include pain or tenderness to the touch in the upper left part of the abdomen,
left shoulder and left chest wall, as well as confusion and light-headedness. If any of the symptoms are observed after a trauma, immediate emergency medical attention is life saving. Under clinical settings emergency sonography or abdominal CT (computer tomography with or without contrast fluid) examination can precisely differentiate between potential sub-capsular injuries as hematomas from life threatening mass bleeding.
Treatment options
Treatment options depend on the condition of the injury. Mostly, a conservative nonoperative treatment regime is recommended.
Spleen function & injury patterns
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Polo Times, December 2020 / January 2021
Photography courtesy of Polodoc
The spleen is the largest organ in the lymphatic system. It is an important organ for keeping bodily fluids balanced, but it is possible to live without it. The spleen is located under the ribcage and above the stomach in the left upper quadrant of the abdomen. A spleen is soft and generally looks purple. It is made up of two different types of tissue. The red pulp tissue filters the blood and gets rid of old or damaged red blood cells. The white pulp tissue consists of immune cells and helps the immune system fight infection. Spleen lacerations or ruptures usually occur from a blunt blow to the abdominal region. These blows can break in the spleen’s surface and can lead to severe internal bleeding and signs of shock (fast heart rate, dizziness, pale skin, fatigue). Without emergency care, the internal bleeding could become life-threatening. On the continuum of spleen breakage, a laceration refers to a lower-grade extent of injury, where just a part of the spleen is damaged. A ruptured spleen is the highest grade of broken spleen injury.
CT Picture of the abdomen with laceration of the spleen
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