Bucs/NFL

Symptoms not always clear

Spleen injuries can often mimic less grave conditions, such as dehydration and heat exhaustion.

By DAVE SCHEIBER
Published September 26, 2006

Surgeons from Tampa Bay and around the country were in agreement Monday: The symptoms for a ruptured spleen are easily confused with signs of dehydration and a physical pounding, like those Chris Simms experienced in Sunday's loss to Carolina.

"The problem with an injury like this is bleeding, and the issue is recognition and treatment," said Dr. Alex Rosemurgy, director of Digestive Disorders Center at Tampa General Hospital and professor and director of the Division of General Surgery at the University of South Florida.

"The problem with a splenic injury in a setting like this is that you're talking about world-class athletes and, with all the other issues going on, it can be very difficult to diagnose. It's a real testament to the doctors who took care of him that he got as excellent care as he did.

"I don't know how many times he got hit but it was a bunch," Rosemurgy added. "There would be no reason he should be feeling very good. So it would be easy to have a life-threatening problem like that go missed, and thankfully for him it did not. He may, in fact, have had heat exhaustion. It's not clear to anybody when the injury happened and all this stuff would be speculative."

Dr. W. Scott Melvin, chief in the division of general surgery at the Ohio State University Medical Center, underscores that the nature of the injury can make it hard to detect at first.

"A ruptured spleen will continue to bleed over time, so it's very commonplace that it's a little bit of a delayed diagnosis, because the symptoms are not specific," he said. "Often, people have left-sided pain, abdominal pain and feel terrible. Eventually the blood loss will lead to low blood pressure and subsequent light-headedness and dizziness and that kind of thing."

Just how much danger was Simms in by staying in the game while bleeding internally from the ruptured spleen?

"Anything can happen, but most young people will tolerate bleeding from the spleen quite well," Melvin added. "Most life-threatening injuries with spleens usually happen in the context of multiple injuries, if somebody is in a motor vehicle accident or a motorcycle accident. You hear about people who die from a ruptured spleen, well, they've been hit by a car and have a broken leg and a head injury, and they're laying alongside the road for a couple of hours."

Dr. Nick Price, a general trauma surgeon at Bayfront Medical Center, echoes that point. "It's rare these days for people to die from splenic rupture, because we usually catch it and take it out before anything happens," he said. "The spleen is something that bleeds slowly."

Often, the bleeding from the spleen does not cause pain initially, he said. "What's painful is where they get hit, like in the chest wall. The spleen lays underneath the left side of the posterior lateral chest and when people get hit on the left side of the chest, they usually have rib fractures and that's what hurts."

Price says he sees spleen injuries frequently in the emergency room. "It's an injury you have to be very cognizant of and we look for it if they come in the ER," he said. "Usually they come in complaining of pain. They may get light-headed from a drop in blood pressure. You don't always have to take the spleen out when it's bleeding. A lot of times it will tear and then stop bleeding and they'll just heal on their own."

When he does remove a spleen, Price's patients are generally out of commission for eight to 10 weeks because the surgery involves a major incision of the abdomen.

In Simms' case, with the physical abuse quarterbacks endure, the wait would certainly be longer. "I don't think he'd be able to go back for a good three or four months," Price said. "(But) he could go back next year."

As for his long-term prognosis without a spleen, a non-essential part of the immune system that filters and holds extra blood, Price foresees no problems.

Price is surprised there aren't more spleen injuries in the NFL. "These guys are so muscular, I think (their chest wall) protects them," he said. "They're pretty strong guys. Look, this guy probably had it injured and kept playing. That's how tough he was."

Simms, of course, does not have an overly muscled physique, unlike many of his teammates.

"That would make a difference," Price said. "The more padding you have, the better off you are."

[Last modified September 26, 2006, 01:35:06]