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Splenectomy

A splenectomy is a procedure in which the whole spleen is removed. The spleen is the size of a fist and is located near the stomach just under the rib cage on the left. The spleen is an important organ, filtering the blood and containing certain white blood ells that kill bacteria and prevent infections in the body. The spleen also filters and removes old red blood cells from the body. The spleen can be completely or partially removed. If only a portion of the spleen is surgically removed, the procedure is known as a partial splenectomy.

A splenectomy may be necessary if the spleen is injured or has ruptured. Ruptured spleens are very serious and can be life-threatening. An emergency splenectomy can take care of the problem. Ruptured spleens occur in motor vehicle accidents and contact sports incidents.

Cancer of the spleen can happen and can necessitate a splenectomy. Related conditions can cause the spleen to swell and be in danger of rupturing. Other conditions, such as systemic lupus erythematosus or lupus and sickle cell anemia can result in a shriveled spleen that fails to function.

Most commonly, the condition called ITP or idiopathic thrombocytopenic purpura, results in the need to remove the spleen. This is an autoimmune disease that chews up important platelets. The spleen makes antibodies to these platelets so that it must be removed to increase the platelet count.

Other reasons behind needing to have a splenectomy include:

• Having hereditary nonspherocytic hemolytic anemia.
• Having hereditary elliptocytosis.
• Having hereditary spherocytosis.
• Having thalassemia.
• An aneurism in the splenic artery.
• A blood clot in the splenic vasculature.
• Having leukemia .
• Having some kinds of lymphoma.

A splenectomy is done under general anesthesia. The procedure can be done via an open procedure or using a laparoscopic procedure. If a laparoscope is used, a small incision is made in the left upper quadrant of the abdomen and a camera is inserted to light the space. Other small incisions are made to incorporate the tools used to remove the spleen. Carbon dioxide is used to inflate the abdominal cavity to make things easier to see during the surgery. The spleen is removed and the incisions sutured.

If there are bleeding troubles during the laparoscopic procedure, the doctor may have to switch to using an open procedure. The recovery time is longer but it gets the job done more safely. As people can have smaller extra spleens, it is up to the general surgeon to look for them and remove them at the time of surgery. It is estimated that about 15 percent of people have more than one spleen.

There are complications from having a splenectomy. While you can survive without a spleen, you have an increased risk of infection without a spleen. Some infections you can get, in particular, are Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Fortunately, there are vaccinations against these bacteria which can protect those who are no longer capable of fighting them off very much. If the patient is not immunized and gets an infection, the mortality rate is about fifty percent.

There are other complications of a splenectomy. These include the following:

• Getting a blood clot in the hepatic vein.
• Getting a local infection at the site of surgery.
• Developing a hernia at the site of the incision.
• Pancreatic inflammation, also called pancreatitis.
• Surgical injury to the stomach, colon, or pancreas.
• Collapse of the lung.

Signs and symptoms of a complication that require immediate attention include heavy bleeding, the development of chills, problems eating or drinking, shortness of breath, cough, pain that can’t be controlled with oral pain medications, redness, pain or purulence at the site of the incision, nausea or vomiting that does not go away or having a fever of greater than 101 degrees.