Spleen Injuries in Athletes

A high school football player is hit in the stomach while running the football. The collision is hard and "knocks the breath out" of the player. He lies on the field gasping for air while the coach and certified athletic trainer (ATC) check on him. The athlete calms down, takes a few deep breaths, then jumps up. He rests on the sideline for a few minutes, and the coach puts him back in the game on the next play. He comes off the field a few plays later and tells the ATC that his stomach hurts where he got hit. He begins to feel nauseated, so the ATC asks him to lie down on the bench. The player reports that his left shoulder hurts. The ATC suspects that the athlete has an injured spleen and tells the coach that the player needs to go to the emergency room as soon as possible. In the emergency room, the athlete is examined and tested. Later that night, he has surgery to repair his ruptured spleen.

Why is the spleen important?
The spleen is one of the body's largest organs and serves the blood production and filtering system. It is located under the left side of the rib cage and can be injured with direct contact to that area. The spleen acts as a reservoir of red blood cells and a producer of white blood cells; therefore, an injury to it sometimes results in blood spilling into the abdomen. However, the organ is encased in a tough, fibrous capsule that helps hold it in place. If the capsule is not torn, it can limit the amount of blood that seeps into the abdominal space after injury.

This organ also is very active in producing antibodies for the immune system. When an athlete has mononucleosis (commonly called "mono" or "kissing disease"), the spleen enlarges to produce more antibodies and more white blood cells and to continue acting as a blood filter. These functions are vital for the athlete with mononucleosis. However, if the sick athlete participates in contact and collision sports, he or she has a higher risk of injury to the spleen. Often, the enlarged spleen protrudes from its normal position under the protection of the rib cage. Therefore, the spleen can be ruptured easily with a direct blow to the left side of the upper abdomen. As a result, athletes with mononucleosis are restricted from contact and collision sports. Once the athlete has recovered from mononucleosis and a doctor has confirmed that the spleen is no longer enlarged, the athlete may participate in his or her sport once again.

In a healthy athlete, the spleen is subject to injury when the athlete's body makes contact with another athlete or an object, such as a fence or bench. The athlete described previously recovered and was able to return to football because his injury was recognized promptly and treated correctly. If your athlete has symptoms of nausea, stomach pain, and pain in the left shoulder after a blow to the stomach, take him or her to a doctor or to an emergency room for immediate evaluation.

Bruce Getz, ATC
Columbus, Georgia