Spleen Problems and Spleen Removal

Spleen removal is indicated if you have certain medical conditions.

The spleen is a small organ located on the left side of the abdomen under the rib cage. The spleen is part of the immune system and plays an important role in fighting infections. The spleen also filters damaged and old cells out of the bloodstream, for example, old or damaged blood cells.

Surgical removal of the spleen is called splenectomy. The most common reasons to do a splenectomy are to treat a ruptured spleen, an enlarged spleen or other disorders of the spleen and blood disorders. 

A splenectomy may be indicated in the following conditions 

• Ruptured spleen: The spleen may rupture due to a severe abdominal injury or because of an enlarged spleen (splenomegaly). This causes severe internal bleeding and can be life threatening.
• Enlarged spleen or splenomegaly: Splenomegaly causes symptoms such as pain and a feeling of fullness. Splenectomy can help resolve these symptoms.
• Cancer: Cancers that may be treated with splenectomy are usually cancers of the blood and lymph system, such as chronic lymphocytic leukemia, Hodgkin's lymphoma, non-Hodgkin's lymphoma or hairy cell leukemia.
• Blood disorders: Blood disorders that may be treated with splenectomy include thalassemia, sickle cell anemia, idiopathic thrombocytopenic purpura and  polycythemia vera. 
• Infection: A severe infection or the development of a large abscess (collection of pus) with surrounding inflammation in the spleen may require splenectomy if other treatments fail.
• Storage disorders: Some children born with genetic defects may have diseases called “metabolic disorders” such as Gaucher’s disease. These may cause the spleen to become enlarged.
• Cyst or tumor: Noncancerous cysts or tumors inside the spleen may require splenectomy if they are too large that the tumor alone can’t be removed, indicating the removal of the entire spleen.

Splenectomy is a relatively safe procedure. But as with any major surgery, splenectomy has a risk of complications, including:

• Bleeding
• Hematoma (blood clots)
• Infection
• Injury to nearby organs, including the stomach, pancreas and colon

Long-term complications of splenectomy include the risk of infection.Since the spleen plays an important role in the body’s immune system, splenectomy tends to compromise the body’s immunity. Hence, post surgery the patient is prone to develop frequent infections, many of which can be life threatening. The doctor may recommend vaccines to prevent pneumonia, influenza, Haemophilus influenzae type b (Hib) and meningococci. Preventive antibiotics may be prescribed, especially if there are other coexisting conditions that increase the risk of serious infections, such as diabetes and HIV.

Before surgery

• Patients may have to temporarily stop taking certain medications and supplements as advised by the doctor.
• Patients may receive blood transfusions prior to surgery to ensure sufficient levels of blood cells after the spleen is removed.
• Vaccines against preventive infections would be administered. 

During surgery

Surgery is performed under general anesthesia. 

There are two surgical techniques

Laparoscopic splenectomy: Four small incisions are made in the abdomen through which a tube with a camera and light (scope) and surgical instruments are inserted to perform surgery. 

Open splenectomy: Laparoscopic splenectomy, though less invasive, may not always be possible, such as in the case of a ruptured spleen or in the presence of dense scar tissue from a previous surgery. During open splenectomy, the surgeon makes an incision in the middle of the abdomen and then performs surgery.

After the procedure

• Painkillers and antibiotics would be administered. 
• In case of laparoscopic surgery, patients may be discharged in 24 to 48 hours. In open surgery, patients are discharged after two to six days.
• Recovery after laparoscopic surgery is about two weeks and recovery after open surgery takes six weeks.

After splenectomy, other organs in the body take over most of the functions previously performed by the spleen. Patients can be active and live a normal life without a spleen, but there is an increased risk of acquiring serious infections, which can be managed medically. 

The patient may only need to stay in the hospital for a few days following the surgery. The surgeon or doctor will tell the patient when they can return to their normal activities.