Definition & Overview
The spleen is a fist-sized organ in the upper left side of the abdomen behind the left ribs. It is part of the immune system, which functions include fighting off germs that invade the blood, removing damaged or old red blood cells, and controlling the level of blood cells.
The spleen can rupture or become damaged due to a fracture to the ribs, forceful blow to the abdomen, and sporting or car accidents. A ruptured spleen is a medical emergency. A trip to the hospital is needed so that appropriate medical care and examination can be immediately provided.
Surgeons can repair ruptured spleen with simple sutures or stitches. For worst cases, the spleen or a part of it is removed through partial or full splenectomy. There are, however, complications of living without a spleen as it makes the patient more prone to suffering from sepsis and other life-threatening infections.
Who Should Undergo and Expected Results?
Patients with any type of spleen injury must seek medical attention. These patients typically present with the following symptoms:
- Tenderness and pain in the upper left abdominal area
- Pain in the left shoulder
- Dizziness, lightheadedness, and confusion
How is the Procedure Performed?
Prior to providing treatment, the condition is diagnosed using the following tests and procedures:
- Physical exam
- Blood exams – Abnormal platelet counts and the presence of blood clots are some of the indications of a spleen problem
- Ultrasound of the abdomen
- Computed tomography (CT) scan – If the above tests do not provide sufficient information, the doctor will require the patient to undergo a CT scan. This imaging procedure can rule out other diseases and specifically determine if the spleen is the one causing the symptoms or not.
The treatment for a ruptured spleen depends on the severity of the condition. Mild cases can be managed with non-surgical interventions while severe ones may require invasive surgical procedures. Small tears can be managed by suturing the injured area. In other cases, a procedure called arterial embolisation is performed. The doctor may suggest the removal of the spleen or a part of it in worst-case scenarios. However, this is becoming less common as more alternative treatments are now available to save the organ.
The removal of the spleen through splenectomy is the last option. The procedure is performed only if the spleen is bleeding profusely or if the patient shows no vital sign or abnormally low blood pressure due to spleen infection.
Recovery depends on the patient’s age, the severity of the injury, and if the patient has other diseases. Younger patients typically recover fast and suffer fewer complications.
Because the spleen is involved in immune response, the body is less able to fight off infections without it. Patients are therefore more prone to blood-related bacterial infections such as sepsis. As a preventative measure, they are given vaccination against common infections.
Surgeries that involve the spleen can be performed using laparoscopic or minimally invasive techniques, which only require small incisions near the left abdomen. A flexible tube with a tiny camera and special surgical tools are inserted through these incisions to perform the surgery without the use of long incisions. This type of surgery significantly minimises risks and complications as well as recovery period and postoperative pain.
Possible Risks and Complications
The surgical treatment of the spleen is generally safe, but like any other invasive treatment, it has risks and mild to severe complications including bleeding, blood clots, sepsis, pneumonia, and other blood-related infections and diseases.
The surgeon will require the patient to temporarily stop engaging in strenuous physical activity during the recovery period. Any heavy lifting or arduous physical activity could contribute to increased abdominal trauma and induce bleeding and may further rupture the spleen.
Children and young adults are particularly vulnerable to infections when their spleen is removed. For children, a daily intake of antibiotic is required to prevent bacterial infection in the blood. Adults may only take antibiotic when needed or only when they manifest symptoms of a bacterial infection.
Chen J, Ma R, Yang S, Lin S, He S, Cai X. Perioperative outcomes of laparoscopic versus open splenectomy for nontraumatic diseases: a meta-analysis. Chin Med J (Engl). 2014 Jul. 127(13):2504-10. [Medline].
Poulin EC, Schlachta CM, Mamazza J. Splenectomy. Ashley SW et al, eds. ACS Surgery: Principles and Practice. Hamilton, ON: BC Decker Inc.; 2010.