Splenic Artery Avulsion in a High School Football Player: A Case Report

OBJECTIVE: To present the case of a high school football player who sustained avulsion of 2 branches of the splenic artery from his spleen as he was tackled and landed on the football. BACKGROUND: A high school football player was tackled and fell onto the football, left side first. He was examined by a certified athletic trainer and an internist. On evaluation, he had a positive Kehr sign, exquisite left upper abdominal quadrant tenderness, and complaint of nausea. He also exhibited signs of the onset of shock, including diaphoresis, a rapid pulse, and hypotension. He was immediately transported by ambulance to the local emergency facility. DIFFERENTIAL DIAGNOSIS: Splenic rupture, splenic laceration, splenic artery avulsion, or ruptured viscus. TREATMENT: Emergency surgery was performed, with removal of 2800 mL of blood and ligation of the 2 arterial branches avulsed from the spleen. The patient fully recovered within 6 weeks and was cleared to resume all sports activities. UNIQUENESS: Injury to the spleen in football is a known yet very uncommon injury. Even more unusual is the avulsion of splenic artery branches from the spleen. CONCLUSIONS: It is critical that athletic trainers and team physicians have an understanding of the mechanisms, signs, and symptoms of splenic injury. Because the spleen is a highly vascular organ, severe hemorrhage can be fatal in just minutes if not recognized and appropriately treated.