By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- The spleen is the most commonly injured abdominal organ during sports
- An enlarged spleen, such as from mononucleosis, places an athlete at additional risk of injury to the spleen
- Emergency treatment is critical to ensure the health of the athlete after a possible spleen injury
This week I was working with a college lacrosse player who was seeing me for ongoing issues with groin pain. Unrelated to that he indicated to me that in the past season he was hospitalized for a week due to a laceration of his spleen. The laceration occurred during a lacrosse game when he was diving for a ball and an opposing player’s stick hit him just underneath his left rib cage. My patient was fortunate in that he has made a full recovery and should go on to have normal function of his spleen. But others have not been quite so lucky.
A young man named Evan Murray, a 17-year-old three-sport athlete at Warren Hills Regional High School in New Jersey took a hit in the backfield during a football game in 2015. According to witnesses who spoke to the media, Murray walked off under his own power but later collapsed. As he was placed on a stretcher to be taken to a local hospital, he told his teammates he would be fine and gave them the thumbs-up sign.
But tragically, Evan Murray didn’t make it.
According to the County Coroner’s Office, the cause of death was a lacerated spleen that caused massive internal bleeding. Dr. Ronald Suarez found that Murray’s spleen was abnormally enlarged, making it more susceptible to injury.
What is the spleen?
The spleen is an organ in the upper far left part of the abdomen, to the left of the stomach. The spleen plays multiple supporting roles in the body. It acts as a filter for blood as part of the immune system. Old red blood cells are recycled in the spleen, and platelets and white blood cells are stored there. The spleen also helps fight certain kinds of bacteria that cause pneumonia and meningitis.
Some medical conditions can result in an enlarged spleen, and an enlarged spleen is a risk for rupture. One of these conditions commonly seen in young athletes is mononucleosis, otherwise known as “mono”. For this reason, most physicians will require an athlete to rest for several days after mono before return to sports. This gives the spleen a chance to return to normal size.
Mechanism of spleen injuries
While death from spleen injuries is thankfully rare, the spleen is actually the most frequently injured abdominal organ in sports. A direct blow to the left side of the upper abdomen in contact or collision sports like football, lacrosse, or hockey, can injure the spleen in a healthy athlete.
Recognition of spleen injuries
A huge amount of blood travels through the spleen. Laceration or rupture can lead to massive bleeding into the abdomen that can be catastrophic.
Spleen injuries can be hard to diagnose at the time of injury. A player might have upper left abdominal pain after a hard tackle to the body, or being hit by the backend of a stick. He might complain of left shoulder pain from blood irritating the diaphragm. A doctor or athletic trainer might find tenderness when feeling the abdomen or ribs over the spleen.
Recognition and treatment of athletes with spleen injuries
Immediately after the injury, the athlete may have very few complaints and the exam could look nearly normal. It’s incredibly important therefore to pay close attention and act quickly if the young athlete develops any signs of abdominal pain. Evaluation of the athlete at a hospital is critical if there is any question of a serious injury.
Many athletes with ruptured spleens require surgery and sometimes removal of the spleen. Some types of spleen injuries can be successfully treated without surgery. My young patient required a week in the hospital. These athletes usually do well and lead healthy lives, often returning to sports.
Evan Murray’s death was devastating for his hometown. Maybe one positive outcome will result from this tragedy. Parents, coaches and athletes can become more aware of these injuries so that no more athletes die from them in the future.