Healthy Living: January 16, 2018

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Snowmobile and skiing season is upon us. If there is one thing Mainers know how to do in the winter, it is embracing the snow and turning it into a fun activity. These activities do come with their attached risk however and it is always useful to abide by standard safety precautions. When accidents occur, some injuries are immediately obvious and lead people to seek medical care as soon as possible such as open lacerations and broken bones. Some injuries, while very common, are less obvious and only manifest themselves over time and often very late, unless first responders are aware of the accident. Spleen injuries fall in that category and it is always advisable for the public to be aware of them and of their repercussions. The spleen is an intra-abdominal organ present in the left upper side of the abdomen, partially covered by the rib cage. I always describe the spleen as bag of blood because of how richly perfused it is. Subsequently, injury to the spleen usually results in a certain degree of bleeding. Many people have conditions that lead the spleen to be larger than normal, a condition known as splenomegaly. This makes the spleen even more prone to bleeding. The spleen has a very important function in immunity and filtering the blood. We can live without our spleen but it makes us more prone to certain types of infections. There are vaccinations that protect us from these infections if spleen has to be removed for any reason. Bleeding from the spleen can be painless, and when blood accumulates to a certain degree in the abdomen, it will start to cause pain. Acute bleeding can also cause low blood pressure, dizziness, and weakness but lower levels of bleeding can be silent for a relatively long duration. This is why it's important to seek medical attention after significant trauma despite the lack of symptoms. We usually discover splenic injuries with the help of a CT scan. Abdominal ultrasound allows us to know if there is significant blood in the abdomen but not necessarily the source. CT scan appearance allows to grade splenic injuries from 1 to 5 with 1 being the mildest and 5 being the most severe. These grades are useful to allow doctors to predict how the injury will evolve and what needs to be done. Interventions range from simple observation to surgery depending on grade. Low grade injuries tend to stop bleeding spontaneously and most of the time only require observation in the hospital and serial blood checks. Higher grade injuries may require embolization which is a procedure performed by an interventional radiologist where under x-ray guidance, the bleeding vessel is found and a sort of plug is sent through the vessel to stop the bleeding. More robust bleeding may require emergent surgery to remove the spleen. In these cases, vaccinations have to be given to patient before they leave the hospital. When the spleen is injured and not removed, it remains fragile and vulnerable for a certain duration so we often advise patients to avoid contact sports or any activity that puts them at risk for further abdominal trauma. Splenic injuries can be very mild but can also be life threatening. Make sure to be safe and diligent this snow season to stay healthy