Spleen injury
The spleen is the most vulnerable to damage visceral organs. “Su asked ban on gill” pointed out: “thorn in the spleen, the 10th death, his move to swallow.” Reports of accidental injury spleen acupuncture first appeared in 1957 [1]. Although the spleen in the normal position within the projection area of its surface without Meridian distribution, but improper acupuncture spleen injury, causing splenic rupture reported, are not uncommon.
[Injury]
A pathological reason: This is the main reason for acupuncture injure the spleen. Normal adult spleen about palm large shape like beans. Deep in the left hypochondrium was nine, ten, eleven ribs are covered. Spleen and peritoneal folds around the nearby organs connected to form various ligaments of the spleen from the support and fixation. Since the surface projection of the area without the spleen meridian distribution, the location is more fixed, but also for protecting the ribs, it is usually the case, acupuncture can not hurt. However, often due to a disease of spleen such as malaria, leishmaniasis, schistosomiasis and other swelling occurs when the spleen volume increases, extended upward, raising the diaphragm can be inserted into the left upper abdomen down. Huge spleen can sometimes reach the left iliac, and even into the right abdominal cavity. Such lesions spleen, swimming degrees below normal, while the brittleness increased significantly. At this time, not only its neighboring points, such as the chapter left doors, Beijing doors, abdominal and stomach points and so sad at acupuncture points can lead to injury, and involves more other abdominal cavity. And because the enlargement of the spleen oppression abdominal wall, so that was significantly shorter spines Road, acupuncture according to the increasing chance of injury. In addition, some doctors do not understand the disease in the case of deep abdominal stab blind treatment “lump”, but also lead to a ruptured spleen causes.
Second, the reason for the action: The spleen is the most prone to rupture of intra-abdominal organs, slightly damaged by external forces can rupture. Spleen is one of blood-forming organs, blood supply is extremely rich, so once the rupture, often causing heavy bleeding. Therefore, excessive deep puncture, the needle substantially etc., can cause serious damage. Acupuncture mistakenly spleen, such as needle retention time is longer, because the spleen normally move up and down with diaphragmatic breathing, deep part of the spleen needles rip it constantly increases, resulting in increased spleen parenchymal hemorrhage.
In addition, deep needle, such as coughing, or because of other causes of pain and breathing deeply, spleen, diaphragm with the increase range of motion, but also easy to cause or aggravate the spleen rupture.
Clinical manifestations
Splenic rupture due to the extent, scope and bleeding situation is different, its clinical manifestations vary syndromes.
Mild: Usually no obvious symptoms, some patients have only left upper abdominal discomfort or feel a sense of pain or tenderness in the left upper quadrant mass reach, and more in the acupuncture point.
It is worth noting: needle-stick injuries, needles central cause rupture of the spleen (splenic parenchyma break in deep) and subcapsular rupture (break in the splenic parenchyma peripheral portion) of two different types of damage, but no matter what type, can Tension hematoma formation. Initially, the patient may not have any symptoms, however, still in the spleen, bleeding, hematoma may continue to increase tension. When the pressure reaches a certain level, blood clots will break through film, form a true rupture, leading to intra-abdominal bleeding, patients often rapid shock, and even untimely death, in which case more than 1 to 2 weeks after the injury occurs around the need to improve vigilance.
Severe: Severe abdominal pain, left upper quadrant begin limited. With increased bleeding, into the abdominal cavity, gradually that whole abdominal pain, but still most famous left upper quadrant. Blood stimulate the peritoneum, causing peritoneal irritation symptoms: abdominal rigidity, tenderness, rebound tenderness, and nausea and vomiting. Some patients because of the blood to stimulate the diaphragm, appear left shoulder pain. Rapid bleeding who a short time as follows: irritability, thirst, palpitations, cold sweats, pale, or even conscious indifference, pulse rate and micro, blood pressure and go into shock. Laboratory tests: red blood cell count, hemoglobin decreased progressively, increased white blood cell count. Ultrasound: can be found within the abdominal cavity fluid, spleen volume increases, especially for subcapsular rupture can make a timely diagnosis. X-ray examination: abdominal X-ray shows left diaphragmatic elevation, limited range of motion, etc.; X-ray showed splenic shadow disappear or become deformed. Abdominal puncture, such as not coagulated blood sucked out, combined with the history of the left upper abdomen, and other clinical evidence of acupuncture-like, can be diagnosed as rupture.
[Prevention]
One familiar with the anatomical location of the spleen: acupuncture treatment, abdominal palpation should first understand whether spleen enlargement and enlargement range. In the event of enlargement, less choice or do not choose the projection area of the points.
Second, careful operation: in the spleen is normal, such as taking the projection area near the spleen points (such as Zhang doors, Beijing doors, door beams, abdominal sorrow, etc.), be careful not to spleen obliquely, deep puncture. Splenomegaly, and even more suitably shallow stab or cross-needling, the tip should be kept in the myometrium. To have the fear of pain or severe coughing patients should avoid election projection area and near points. If accidentally puncturing the abdominal cavity, the tip touches the spleen capsule, doctors who often feel some resistance, then that is required to retire from the needle, must deep puncture, or subjected to mention pound the law. Needle retention period, the patient appears at the needle as pain and discomfort felt, it should immediately go to the needle, and to strengthen the observation.
In addition, in the case of unknown disease conditions, but also must not be blind deep thorn “lump in the abdomen.”
[Processing Method]
One, mild: no obvious clinical symptoms, can be supine rest, and give hemostatic drugs for symptomatic treatment. But for such patients, close observation must be 2 to 3 weeks, in the event of bleeding, treatment should be immediately forwarded Division.
Second, severe: most patients have to turn surgery. Shock, should first of all anti-shock, including rapid blood transfusion, rehydration. As splenic parenchyma very fragile, not stitched, patched, so the diagnosis of splenic rupture has been established, should be implemented splenectomy.