The spleen is an organ which is the size of one’s fist located under the rib cage on the left side, above the stomach. The spleen helps in fighting infection; destroying damaged and old cells and controlling amount of blood in the body. The spleen needs to be removed surgically, if it is damaged due to injury or disease. This procedure is called as splenectomy.
Need for splenectomy
Splenectomy needs to be performed to treat a damaged or ruptured spleen that can be caused due to abdominal injury or due to enlargement of spleen known as splenomegaly which can cause internal bleeding. Splenectomy is done to avoid a life threatening situation. The procedure of splenectomy may also be needed in blood disorders like sickle cell anemia (red blood cells are sickle shaped), thalassemia(inherited blood disorder), idiopathic thrombocytopenic purpura(low platelet count) and polycythemia Vera (increase in red blood cells in bone marrow). If the spleen has been affected by cancers like Hodgkin’s disease( cancer of white blood cells), chronic lymphocytic leukemia(blood cancer) and non Hodgkin’s lymphoma(cancer of lymphatic system), splenectomy is performed. The other reasons due to which the doctor can recommend splenectomy includes hairy cell leukemia (type of blood cancer), abscess of the spleen, and non cancerous cysts and tumors.
Detecting the problem
To detect the need for splenectomy, a blood test is done in which the complete blood count is checked. The bone marrow is also examined. Diagnostic procedures like an Ultrasound, Magnetic resonance imaging (MRI scan), nuclear scan and Computerized Tomography (CT scan) is also done.
Procedure of splenectomy
The splenectomy is done under general anesthesia, wherein the patient will not be conscious. The anesthesia is administered to the patient through a mask in the form of gas or injected intravenously in liquid form. Vital signs like blood pressure, heart rate, and blood oxygen are monitored by the health care team. In a surgical procedure known as minimal invasive laparoscopic splenectomy, incisions are made on the abdomen and a tube with a camera is passed through one of the incisions into the abdomen. The images of the internal structures are captured by this video camera which is transferred to the monitor in the operating chamber. The surgeon looks at the monitor for guidance and performs the splenectomy by passing surgical tools through the incisions on the abdomen. After the procedure, the incisions are closed.
In the procedure known as open splenectomy, incisions are made in the middle part of the abdomen, and all the muscle and tissues in the way of the spleen are removed. Once the spleen is located, it is removed and then the incisions are closed.
Recovery
After the surgery, the patient is closely monitored by the healthcare team for any complications, and at least 3 days stay in the hospital is necessary before discharge. The doctors generally recommend a week’s rest from work and other activities after surgery. A normal diet can be taken by the patient unless he is a diabetic. Constipation may occur due to painkillers for which drinking plenty of water is recommended. Complete recovery takes 4 weeks to 6 weeks after surgery.
Complications after splenectomy
Like in any surgery, there are certain complications that can occur. These include:
- Formation of blood clots
- Infections of the kidney, lung and bladder
- Breathing problems
- Blood loss
- Heart attack
- Reaction to medication
- Injury to stomach, pancreas and colon
- Formation of blood clot in the portal vein that carries blood to the liver
The doctor should be called immediately, if the person develops continuous fever over 101F (39C) with chills accompanied by shortness of breath and continuous cough. The person should also be watchful of swelling in the abdomen, increase in pain, pus discharge from any incision, and redness around incisions that gets worse with time. Presence of nausea and vomiting and inability to drink or eat anything also requires immediate medical attention.
Preventing Infection
After splenectomy, there is increased risk of infection as spleen is an organ that helps in fighting infection. It is important to tell the dentist and other doctors about the splenectomy. A pneumococcal vaccination needs to be given before splenectomy and a booster shot once every 3 years to 5 years. The doctor may also recommend shots for meningitis, flu, and haemophilus infection. Children after splenectomy need to take antibiotics for 2 years after surgery or till they are 21 years of age. It is important to talk to the doctor before travelling to other countries. There is an increased risk of getting malaria, babesiosis (infection transmitted by deer ticks). Immediate medical aid must be taken in case of dog bites.
