Spleen problems and spleen removal

Some people are born without a spleen, and others need to have it removed because of disease or injury.

The spleen is an organ about the size of your fist. It sits 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, because the liver can take over many of its functions.

The spleen does a few important jobs in your body.

It fights germs that get into the blood, because it contains infection-fighting white blood cells. It also controls the level of blood cells, meaning the white blood cells, the red blood cells and the platelets (small cells that form blood clots). And it screens the blood, removing any old or damaged red blood cells.

If the spleen doesn't work properly, it may start to remove healthy blood cells too. 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 pain is usually felt behind your left ribs. The area may also be tender when you touch it. This can be a sign of a damaged, ruptured or enlarged spleen.

Your spleen can be damaged or can rupture (burst) after a forceful blow to the abdomen, a car accident, a sporting accident or a fracture of the ribs. The rupture may happen straight away, or it may not happen until weeks after the injury.

The 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, because it can cause life-threatening bleeding.

• you think you've ruptured or damaged your spleen

The spleen can become swollen after an infection or an injury. An enlarged spleen can also be the result of a disease such as cirrhosis, leukaemia or rheumatoid arthritis.

An enlarged spleen doesn't always cause symptoms. When it does, 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 whether your spleen is enlarged 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 be treated for any underlying condition, and your spleen will be monitored. If there's an infection, you may be given antibiotics.

You'll need to avoid contact sports for a while, because an enlarged spleen is more likely to rupture.

Surgery is only needed if the enlarged spleen is causing serious complications, or if the cause can't be found.

You may need an operation to remove your spleen if it's damaged, diseased or enlarged. This operation is called a splenectomy. Sometimes it's more appropriate to remove only part of the spleen, and that's known as a partial splenectomy.

If there's enough time before the operation, you'll be advised to have a series of immunisations.

Most splenectomies are done using laparoscopy, which is also called keyhole surgery.

A laparoscope is a long, thin, flexible instrument with its own light source. It is attached to a camera and sends high definition, magnified pictures back to a TV screen, which guides the surgeon's instruments.

Laparoscopic splenectomy lets the surgeon reach the inside of your abdomen without making large incisions (cuts) in your skin. You will still need a general anaesthetic, though.

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 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 means one large cut is made. You may need it if your spleen is too large or too damaged to be taken out by keyhole surgery. In an emergency, doctors often choose it first because it lets them bring bleeding under control quickly.

You'll be given a general anaesthetic, and you may need to stay in hospital for a few days to recover.

It's normal to feel sore and to have some bruising after a splenectomy, but you'll be given pain relief medicine. 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 go through these risks with you.

You should be given breathing exercises and leg movement exercises to do at home. These lower your risk of getting a blood clot or a chest infection.

The surgical wound can also become infected. If you spot any signs of infection, contact your doctor or the hospital immediately, because you may need antibiotics.

Recovery usually takes a few weeks. Your doctor or nurse will tell you when you can go back to your usual activities, such as driving.

If your spleen needs to be removed, other organs such as the liver can take over many of its functions. This means you will still be able to cope with most infections. But there is a small risk that a serious infection may develop quickly, and that risk stays with you for the rest of your life.

Young children have a higher risk of serious infection than adults, though it is still small. The risk also goes up if you have a medical condition such as sickle cell anaemia, coeliac disease, or a condition that affects your immune system, such as HIV.

Simple precautions against infection can keep this risk as low as possible. Read about vaccinations for children and adults without a fully working spleen.

It's recommended that you take low-dose antibiotics for the rest of your life to prevent bacterial infections when you have no spleen. Antibiotics are particularly important:

• for children under the age of 16
• for the first 2 years after your spleen is removed
• if your immune system doesn't work properly

Watch out for signs of infection, such as:

• high temperature (fever)
• sore throat
• cough
• severe headache
• headache with drowsiness or a rash
• abdominal pain
• redness and swelling around the surgical wound

Your doctor can prescribe a course of antibiotics for you to use if you get an infection. Start taking them at the first sign of infection, and see your doctor as soon as possible. If the infection becomes serious, you will be admitted to hospital.

Bites from animals and ticks (small blood-sucking parasites) can cause infections. If an animal bites you, particularly a dog, start your course of antibiotics and seek medical advice urgently.

If you go trekking or camping regularly, you may be at risk of babesiosis, a rare disease spread by ticks. Try to avoid tick bites by wearing clothes that cover your skin, particularly long trousers. If you become ill, get medical advice straight away.

Health staff will mark your health records to show that you don't have a working spleen. Even so, always remember to tell anyone who treats you, including your dentist.

It's a good idea to carry or wear some medical ID. For example:

• if your spleen is removed, the hospital may give you a splenectomy card to take home with you
• you may want to buy your own medical ID, such as a MedicAlert or Medi-Tag bracelet or pendant

If you need help or emergency treatment, your medical ID will alert the staff to your condition.

Read advice about travelling abroad without a fully working spleen.

The scars from your operation will gradually fade.