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Splenectomy

(Spleen Removal; Removal, Spleen)

En Español (Spanish Version)

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

Splenectomy is the surgical removal of the spleen. The spleen is an organ in the upper left part of the abdomen. It is beneath the ribs and behind the stomach. The spleen filters blood to remove bacteria, parasites, and other organisms that can cause infection. It removes old and damaged blood cells. It can also produce red blood cells and certain types of white blood cells.

Spleen

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Reasons for Procedure

You may need to be treated by having a splenectomy if you have:

  • Trauma to the spleen
  • Spleen rupture due to tumor, infection, inflammatory condition, or medications
  • Enlargement of the spleen
  • Certain blood disorders when other treatments are not working
  • Abnormal formation of fibrous tissue in the bone marrow
  • Damage in the blood vessels of the spleen
  • Some types of leukemia or lymphoma
  • Diseased spleen, due to disorders like HIV infection
  • Tumor or abscess in the spleen
  • Liver disease

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

Factors that may increase the risk of complications include:

  • Obesity
  • Smoking
  • Poor nutrition
  • Recent or chronic illness
  • Diabetes
  • Advanced age
  • Heart or lung disease
  • Bleeding or clotting disorders

What to Expect

Your doctor may do the following:

  • Physical exam
  • Blood and urine tests
  • Review of your current medications
  • Electrocardiogram (EKG)
  • Other tests to evaluate the cause of the spleen enlargement
  • Studies to determine rate of destruction of red blood cells and/or platelets

Imaging studies to look at the abdoment and spleen may include:

Without your spleen, you will be more susceptible to certain infections. You may get vaccines against infections, which may include:

  • Pneumococcal vaccine
  • Meningococcal vaccine
  • Flu vaccine
  • Hemophilus vaccine

Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, like:

  • Anti-inflammatory drugs
  • Blood thinners
  • Antiplatelets

General anesthesia will be used. You will be asleep.

The spleen can be removed through an open incision or through laparoscopic surgery.

An incision will be made in the abdomen over the spleen. The skin and muscles will be pulled back. The blood vessels to and around the spleen will be tied off. This will free the organ. Moist sponges may be placed in the abdomen. The sponges will absorb some of the blood and fluid. The spleen will be removed. If needed, further surgery may be done at this time to repair other organs. The sponges will then be removed.

The wound will be cleaned. The muscles and skin will be closed with stitches or staples. A gauze dressing will be placed over the wound.

A small incision will be made in the abdomen. A laparoscope will be inserted through the incision. The laparoscope is a thin, lighted tube with a small camera on the end. It allows the doctor to see inside your body. Carbon dioxide gas will be passed into the abdomen. This inflates the abdomen and creates more room to work.

Two or three more small incisions will be made in the abdomen. Special tools will be inserted through these incisions. Blood vessels to the spleen will be cut and tied off. The spleen will then be rotated and removed. If the spleen has been ruptured, the abdomen is checked for any other injured organs or blood vessels. If needed, further surgery may be done at this time. The incisions will be closed with stitches and covered with surgical tape.

The removed spleen is sent to the lab for testing.

You will be taken to a recovery room and monitored. You may require a blood transfusion if you lost a lot of blood in the surgery.

About 45-60 minutes

Anesthesia prevents pain during the procedure. Pain and discomfort after the procedure can be managed with medications.

The usual length of stay is 2-4 days. Your doctor may choose to keep you longer if complications arise.

It is important to follow your doctor's instructions for postoperative care:

  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Replace any wet dressings with clean, dry ones.
  • For minor pain, take only medication that does not have aspirin.
  • Avoid vigorous activity, such as exercise or heavy lifting.
  • Avoid driving for about six weeks, or as directed by your doctor.
  • Make sure you get all the vaccines that your doctor recommends.
  • Daily antibiotics may be used in some people to avoid infections, especially in children
  • Be sure to follow your doctor’s instructions.

Recovery time may vary based on the extent of your injuries and any underlying disease or condition. On average, allow about 4-6 weeks for complete healing.

Always let your doctor(s) know that you do not have a spleen. Carry a national splenectomy card, which most hospital hematology departments can give you. When traveling, take special precautions against malaria and other infections.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occur:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • New, unexplained symptoms

If you think you have an emergency, call for medical help right away.

RESOURCES:

American Academy of Family Physicians

http://familydoctor.org

National Institutes of Health

http://www.nih.gov

CANADIAN RESOURCES:

Canadian Family Physician

http://www.cfpc.ca

Canadian Paediatric Society

http://www.cps.ca

References:

Cadili A, de Gara C. Complications of splenectomy. Am J Med. 2008;121(5):371-375.

Hypersplenism. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated June 20, 2011. Accessed September 19, 2013.

Sabiston DC Jr. Textbook of Surgery. 17th ed. Philadelphia, PA: WB Saunders Co.; 2004.

Splenectomy. The Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/splenectomy/hic-splenectomy-spleen-removal.aspx. Accessed September 19, 2013.

10/9/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Systematic review of atraumatic splenic rupture. Br J Surg. 2009;96:1114-1121.

Last reviewed September 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.