After traumatic splenic rupture, if there is a large amount of blood accumulation in the abdomen, mobile turbid sounds may also be found, but because there is often a clot around the spleen, the patient may have a hollow sound in the right lumbar region when lying on the left side and a fixed turbid sound in the left lumbar region when lying on the right side, called the Ballance sign. Reasons for the hollow sound in the right lumbar region when lying on the left side and the turbid sound in the left lumbar region when lying on the right side: Splenic trauma is classified according to the degree of injury, ranging from small lacerations of the splenic envelope to complete rupture of the spleen. Only 1/3 of lacerations occur on the convex side of the spleen; other traumatic injuries tend to have damage to the splenic hilum, and lacerations on the concave side of the spleen tend to be more dangerous than lacerations on the diaphragmatic side due to the thick splenic parenchyma and splenic vessels encasing the splenic hilum. If the splenic parenchyma is injured while the splenic pericardium remains unbroken, a subpericardial hematoma can occur and is not easily detected until the spleen is injured and a large volume of blood accumulates in the abdominal cavity. If the splenic envelope can withstand the pressure, the hematoma will slowly resorb, forming a fibrous scar or pseudocyst. While some small lacerations often stop bleeding on their own, lacerations of the concave surface of the spleen and large vessels often present with a large accumulation of blood in the abdominal cavity, which can be quickly and definitively diagnosed because of its accompanying symptoms of acute blood volume loss and shock. However, such bleeding or ruptured bleeding from larger vessels can occasionally stop on its own, which may be due to some of the following reasons: decrease in splenic vascular pressure and circulating blood pressure, clot formation, sequestration of the omentum, retraction of the intima and thrombus formation in the lumen of the vessel. Reshunting of intrapleural blood flow may also play a role, as arteriovenous shunts have been found to exist. Sometimes, especially after splenic injury in children and young adults, bleeding is often found to have stopped only during surgery. Thus despite the extensive damage to the spleen, there may sometimes be an illusion of relative circulatory stability, but rebleeding may occur at any time, especially after extensive rehydration. 1. Central rupture: It is a deep rupture of the splenic parenchyma with the superficial parenchyma and splenic envelope intact, while a hematoma is formed in the splenic medulla, resulting in a gradually enlarged and slightly bulging spleen. This type of splenic rupture has three regressions: firstly, the bleeding does not stop, the hematoma keeps increasing and the fissure worsens to the point of rupture; secondly, the hematoma becomes infected secondary to the rupture; thirdly, the hematoma can be gradually absorbed or mechanized. 2.Subperitoneal rupture: It is a rupture of the peripheral part of the subperitoneal splenic parenchyma, but the peritoneum is still intact, resulting in the accumulation of blood under the peritoneum. 3. True rupture: It is the simultaneous rupture of the splenic envelope and parenchyma, resulting in intra-abdominal hemorrhage. The grading of splenic rupture is to deal with different degrees of injury in a more principled manner. 1. Based on ultrasound, CT, intraoperative DSA and clinical manifestations, the American Association for the Surgery of Trauma (AAST) published the grading criteria for organ injury in 1989 and classified splenic rupture into the following 5 grades: Grade 1: subperitoneal hematoma, not expanding, surface area less than 10%, peritoneal tear without bleeding, depth less than 1 cm. Grade 2: subperitoneal hematoma, not expanding, surface area 10% to 50%, or parenchymal hematoma without expansion, hematoma diameter less than 5 cm, active bleeding from pericardial tear, or parenchymal laceration 1 to 3 cm in depth, but without injury to splenic trabecular vessels. Grade 3: Subperitoneal hematoma is extended, or the surface area is greater than 50%, subperitoneal hematoma ruptures with active bleeding, intrastromal hematoma is greater than 5 cm, or is extended, and the parenchymal laceration depth is greater than 3 cm or the splenic trabecular vessels are injured but the splenic segment is not deprived of blood supply. Grade 4: rupture of intraparenchymal hematoma with active hemorrhage, laceration involving splenic segment or splenic hilar vessels, resulting in loss of blood supply to a large portion of splenic tissue (25% or more). Grade 5: complete rupture of the spleen with damage to the splenic portal vessels, resulting in loss of blood supply to the whole spleen. 2. The 6th National Splenic Surgery Symposium held in Tianjin in September 2000 adopted the grading standard for the degree of splenic injury, which was recommended by the Splenic Surgery Group and Collaborative Group of the Chinese Society of Surgery as a national unified norm. Grade 1: subperitoneal rupture of the spleen or mild injury to the peritoneum and parenchyma, with a length of spleen injury ≤ 5 cm and depth ≤ 1 cm as seen by surgery. Grade 2: total length of spleen rupture injury 5 cm and depth ≥ 1 cm, but the splenic hilum is not involved, or the splenic segment is vascularly damaged. Grade 3: splenic rupture injury to the splenic hilum or partial dissection of the spleen, or damage to the vasculature of the splenic lobe. Grade 4: extensive rupture of the spleen, or damage to the splenic hilum or splenic arteriovenous trunk.