Doctors now realize that most small and moderate-sized injuries to the spleen can heal without surgery, although blood transfusions Blood Transfusion read more are sometimes required and people must be treated in the hospital.
When surgery is necessary, usually the entire spleen is removed splenectomy , but sometimes surgeons are able to repair a small tear.
The spleen is a relatively fragile organ located in the upper left quadrant of the abdomen, behind the stomach. A severe impact to the left side of the abdomen, such as from a sports or automobile injury, can result in damage to the spleen. Diseases such as leukemia or hemolytic anemia can also require splenectomy. Splenectomy is the surgical removal of the spleen due to injury or illness. During surgery, the damaged spleen is removed and its attachment to other organs is severed.
Although the liver takes over the functions of the spleen after splenectomy, the blood is not filtered as thoroughly as before. Patients are prone to more bacterial infections following splenectomy. There are several potential complications associated with this procedure that should be discussed with a doctor prior to surgery.
The splenic artery brings blood to the spleen from From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.
The Merck Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. If possible, avoid countries where malaria is present. If you can't, speak to your GP or local pharmacist about anti-malaria medicine before you travel. You should also use mosquito nets and insect repellent. Home Illnesses and conditions Stomach, liver and gastrointestinal tract Spleen problems and spleen removal. Spleen problems and spleen removal.
Some people are born without a spleen or need to have it removed because of disease or injury. What does the spleen do? The spleen has a few important functions: It fights any invading germs in the blood the spleen contains infection-fighting white blood cells. It controls the level of blood cells. The spleen controls the level of white blood cells, red blood cells and platelets small cells that form blood clots It screens the blood and removes any old or damaged red blood cells.
This can lead to: anaemia , from a reduced number of red blood cells an increased risk of infection, from a reduced number of white blood cells bleeding or bruising, from a reduced number of platelets Spleen problems Spleen pain Spleen pain is usually felt as a pain behind your left ribs. A damaged or ruptured spleen The spleen can become damaged or may rupture burst after a forceful blow to the abdomen, car accident, sporting accident or fracture to the ribs.
Rupture can happen straight away or it may happen weeks after the injury. Signs of a ruptured spleen are: pain behind your left ribs and tenderness when you touch this area dizziness and a rapid heart rate a sign of low blood pressure caused by blood loss Sometimes, if you lie down and raise your legs, the pain can be felt at the tip of your left shoulder. Enlarged spleen The spleen can become swollen after an infection or injury.
An enlarged spleen doesn't always cause symptoms. Splenectomy having the spleen removed An operation to remove the spleen, known as a splenectomy, may be needed if the spleen is damaged, diseased or enlarged. If there's time, you'll be advised to have a series of immunisations before the operation. Laparoscopy Most splenectomies are carried out using laparoscopy keyhole surgery.
The procedure involves: Making several incisions in your abdomen tummy area. Guiding a laparoscope into your body through one of the incisions, so doctors can see what they're doing. Passing thin instruments into your abdomen through the other incisions, to remove your spleen.
Gas will be pumped into your abdomen to make this easier. Open surgery Open surgery, where one large incision is made, may be needed if the spleen is too large or too damaged to be removed via keyhole surgery.
You'll need a general anaesthetic and may need to stay in hospital for a few days to recover. Afterwards It's normal to feel sore and be bruised after a splenectomy, but you'll be given pain relief medication. This can be a sign of a damaged, ruptured or enlarged spleen. A damaged or ruptured spleen The spleen can become damaged or may burst rupture after an injury, such as a blow to the abdomen, a car accident, a sporting accident or broken ribs.
Rupture can happen straight away or it may happen weeks after the injury. Signs of a ruptured spleen are: pain behind your left ribs and tenderness when you touch this area dizziness and a rapid heart rate a sign of low blood pressure caused by blood loss Sometimes if you lie down and raise your legs, you can feel the pain at the tip of your left shoulder. A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding. An enlarged spleen The spleen can become swollen after an infection or injury.
An enlarged spleen does not always cause symptoms. Otherwise, look out for: feeling full very quickly after eating an enlarged spleen can press on the stomach feeling discomfort or pain behind your left ribs anaemia and fatigue frequent infections easy bleeding Doctors can often tell if you have an enlarged spleen by feeling your abdomen.
Surgery to remove the spleen You may need an operation to remove your spleen, known as a splenectomy, if it's not working properly or it's damaged, diseased or enlarged. Sometimes just part of your spleen can be removed, which is called a partial splenectomy.
Laparoscopy Most operations to remove spleens are carried out using keyhole surgery laparoscopy. The procedure involves: making several small cuts in your tummy guiding a laparoscope into your body through one of the cuts so doctors can see what they're doing passing thin instruments into your tummy through the other cuts to remove your spleen gas will be pumped into your tummy to make this easier The cuts are then stitched up or sometimes glued together.
You may be able to go home the same day, or you may need to stay in hospital overnight. If you go home the same day, someone will need to stay with you for the first 24 hours. Open surgery Open surgery is where one large cut is made. Recovering from spleen surgery It's normal to feel sore and be bruised after a splenectomy, but you'll be given pain relief.
You should be able to eat and drink as normal soon after the operation. Your doctor will talk through these risks with you. Living without a spleen If your spleen needs to be removed, other organs, such as the liver, can take over many of the spleen's functions. Young children have a higher risk of serious infection than adults, but the risk is still small.
This risk can be minimised by following simple precautions to prevent infection. Trauma surgeons used to routinely remove spleens when there was evidence of splenic rupture. Surgery is now avoided in 95 percent of children and 60 percent of adults that have a splenic rupture.
When surgery is performed, it is still common practice to remove the entire spleen, although less severe cases may allow a surgeon to repair a tear and put pressure on the spleen until the bleeding stops. People who remain stable under observation will often undergo further scans for monitoring purposes, including CT scans.
Those in a stable condition may also undergo a procedure called splenic embolization. The procedure aims to stop any bleeding from the spleen. This procedure usually needs to be performed quickly and can help avoid the need to remove the spleen. Splenic embolization requires specialized facilities and staff, including a vascular surgeon or interventional radiologist. They need to be experienced in carrying out a certain type of artery catheterization and in performing embolization techniques.
This is known as a splenectomy. It is normally performed during an emergency laparotomy on a person in an unstable condition. In some cases of less severe spleen damage, the organ may be salvaged during surgery. Instead of being completely removed, it may be repaired with partial removal, patches, repairs, or staples.
There are, however, very limited opportunities for these options. It is important for a person to rest and allow the body time to heal, and only to resume normal activity after receiving the go-ahead from their treating doctor.
People who play sports are advised that they can resume mild physical exertion for three months before resuming their usual training or exercise regimen. This means that all individuals who have undergone a splenectomy should get vaccinated against Pneumococcus. High-risk patients should be vaccinated against Meningococcus and Haemophilus influenzae type B.
These vaccinations are typically given 14 days before an elective splenectomy or 14 days after surgery in emergency cases. Children who have undergone a splenectomy may need to take antibiotics daily to help prevent infection. This can also be important for people who also have autoimmune conditions, such as HIV , and for the 2 years following removal of the spleen. Even after recovery, it is important to inform medical professionals that you no longer have a spleen as this can affect future treatments.
The main complication of a ruptured spleen is bleeding and the problems that can come from it, such as cysts and blood clots. Delayed bleeding and spleen death may also result from a ruptured spleen.
It is often these serious complications that result in surgery. The decrease in immune activity following a splenectomy can lead to an increased risk of infection, so extra precautions should be taken to prevent infections.
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