In young athletes, what are the warning signs of an injured spleen?

The signs of a ruptured or lacerated spleen can be subtle at first, but get worse as internal bleeding progresses.

With the Morris County Medical Examiner's Office determining that Warren Hills High School quarterback Evan Murray died of massive internal bleeding due to a laceration of the spleen, we asked two doctors at University Hospital in Newark - one of the state's three Level One trauma units - about spleen injuries.

Adam Fox is a trauma surgeon, while Gregory Sugalski is medical director of emergency medical services at the hospital.

How easy it to get a lacerated or ruptured spleen? How does it normally happen?

Sugalski: The spleen is probably the most common organ to be injured in blunt trauma. That could be a car accident or high-contact sports, or anything that's going to have a direct blow to the belly.

How common is it?

Sugalski: While the spleen is the most likely organ to be damaged, that doesn't mean this is a common injury.

What are the symptoms?

Sugalski: Patients experience abdominal pain, obviously, typically located in the left upper quadrant. As the blood pools in the belly, the pain in the abdomen becomes more diffuse.

Fox: The symptoms can range from almost nothing to a huge amount of pain in the upper left hand portion of abdomen. People might have bruising, and significant tenderness. They might also complain of pain in the left shoulder, which is a result of the way the nerves are distributed around the abdomen. If someone has left shoulder pain after a blunt trauma - and the shoulder joint itself isn't in pain - that's a cause of concern.

What does the patient typically complain of?

Sugalski: It probably feels like any other muscle contusion that you get from being tackled. I don't think it would necessarily raise alarms right off the bat. But these are the patients that you have to watch.

What is the treatment?

Sugalski: Emergency treatment depends on the grade of the injury. A lot of low-grade injuries can be watched, and supported with fluid or blood transfusions. They don't necessarily need surgery. But if their vital signs are unstable, they'll go to the operating room to have the spleen removed or have the bleeding stopped.

Doctors used to just take it out. Now that we know more about the role of the spleen, doctors are making more of an effort to preserve it, if possible. But if the patient is very unstable, you take the damn thing out.

What's the general timetable for how quickly a patient must seek emergency treatment?

Sugalski: This isn't an injury you die from immediately. You'd have several hours - maybe 6 to 10 hours. Definitely not 24 hours, though. Kids, in general, can compensate for an injury for quite a while. 

Fox: That's one of the potential problem with young people. Their bodies can compensate for blood loss very well because they're healthy. Their resting heart rate might be lower, and very efficient at pumping blood. 

In the case of a young healthy individual whose body works are incredibly efficiently, the healthcare provider may not see a deterioration until significant blood loss has occurred. These patients just compensate so well that shock due to blood loss may not show up as early as it would in other individuals.

Any advice for student-athletes?

Fox: The frequent term is, "Don't be a hero." Kids play off things, they write it off and say, "This will be fine." If you're not starting to feel better in a relatively short period of time, then you need to get yourself evaluated.

Any advice for parents?

Sugalski: If your kid is complaining of pain, take it seriously. If the nature of the complaint is changing, pay attention to that as well.

Fox: If the pain is not going away - or is increasing over a period of time - and if there are other things that don't feel like right, like nausea or difficulty breathing, or feeling faint, then you should seek treatment.