Spleen problems and spleen removal
Some people are born without a spleen or need to have it removed because of disease or injury.
The spleen is a fist-sized organ found in the upper left side of your abdomen, next to your stomach and behind your left ribs.
It's an important part of your immune system but you can survive without it. This is because the liver can take over many of the spleen's functions.
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.
If the spleen doesn't work properly, it may start to remove healthy 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. It may be tender when you touch the area. This can be a sign of a damaged, ruptured or enlarged spleen.
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.
A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding.
Immediate action required: Go straight to A&E if:
- you think you've ruptured or damaged your spleen
Enlarged spleen
The spleen can become swollen after an infection or injury. It can also become enlarged as a result of a disease such as cirrhosis, leukaemia or rheumatoid arthritis.
An enlarged spleen doesn't 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/or fatigue
- frequent infections
- easy bleeding
Doctors can often tell if you have an enlarged spleen by feeling your abdomen. A blood test, CT scan or MRI scan would confirm the diagnosis.
The spleen is not usually removed if it's just enlarged. Instead, you'll receive treatment for any underlying condition and your spleen will be monitored. Antibiotics may be prescribed if there's an infection.
You'll need to avoid contact sports for a while, as you'll be at greater risk of rupturing the spleen while it is enlarged.
Surgery is only necessary if the enlarged spleen is causing serious complications or if the cause can't be found.
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.
It may sometimes be more appropriate to have just part of your spleen removed – a partial splenectomy.
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).
A laparoscope is long, thin, flexible instrument with its own light source. It is attached to a camera and will relay high definition, magnified pictures back to a TV screen to guide the surgeon's instruments.
Laparoscopic splenectomy allows a surgeon to access the inside of your abdomen without having to make large incisions (cuts) in your skin. However, you will still need a general anaesthetic.
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
The incisions will then be stitched up or sometimes glued together. You may be able to go home the same day, or 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, where one large incision is made, may be needed if the spleen is too large or too damaged to be removed via keyhole surgery. Often, in emergencies, this will be the preferred method to rapidly control bleeding.
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.
You should be able to eat and drink as normal soon after the operation.
Like any operation, a splenectomy carries a small risk of complications, including bleeding and infection.
Your doctor will run through these risks with you.
You should be given breathing and leg movement exercises to do at home, to reduce your risk of getting a blood clot or a chest infection.
Another risk is the surgical wound becoming infected. If you spot any signs of infection, contact your GP or hospital immediately, as you may need antibiotics.
Recovery usually takes a few weeks. Your doctor or nurse will advise when you can go back to your usual activities, such as driving.
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.
This means you will still be able to cope with most infections. However, there is a small risk that a serious infection may develop quickly. This risk will be present for the rest of your life.
