Dr for spleen: Splenomegaly Information | Mount Sinai
Enlarged Spleen Symptoms, Warning Signs + 5 Treatments
Did you know you could have an enlarged spleen and not even realize it? It’s true. In fact, most people don’t experience any noticeable symptoms of an enlarged spleen at all!
Another surprise? Research shows that around 3 percent of healthy first-year college students have enlarged spleens. In some cases, people have genetically enlarged spleens, but it doesn’t affect their overall health. However, for others, it can point to problems like an underlying infection, illness or developing disorder. (1)
So what exactly is an enlarged spleen, how can you tell if you have one and how can you treat it if you do? Turns out there are natural ways to deal with this common condition.
What Is an Enlarged Spleen?
As a crucial part our lymphatic system, the spleen is a vital “guardian” organ that we rely on every single day to keep the body free from infections, virus and dangerous pathogens of all kinds. An enlarged spleen, a condition called “splenomegaly,” is a clear warning sign that the immune system is fighting hard to remove threats from the body but failing to do so because it can’t keep up with high demand.
Under normal circumstances, your spleen is about the size of your fist and hardly even detectable to touch during a physical exam. However, when you’re sick or your lymphatic system is triggered for another reason, your spleen swells up and can dramatically grow in size. (2)
An enlarged spleen can sometimes be very noticeable and painful, but surprisingly most people don’t have any symptoms at all and aren’t even aware of the problem they’re experiencing! While an enlarged spleen isn’t always a health concern, it usually points to the fact that the body is trying to defend itself more than usual — and that means it’s a good idea to figure out why that is before it escalates into a bigger and more serious problem.
The Role of the Spleen
The spleen is a brown, oval-shaped organ located in the upper left side of the abdomen just below the rib cage. Part of the lymphatic system, it performs a number of important functions in the body that protect us from the effects of outside “invaders,” stress and certain deficiencies. Think of your lymphatic system like this: If your body were a city, the organs and fluids that make up the lymphatic system would be the policemen, firefighters and the garbage men.
Probably the single most important thing the spleen does is produce antibodies that fight against bacteria and other microbes. In addition, spleen function includes helping keep the blood clean, transporting and balancing fluid levels, maintaining blood platelets, and ushering waste away from muscle and joint tissue.
The spleen ultimately controls the level of circulating red blood cells within the blood, removing old and worn-out red cells that can no longer do their jobs. It also very importantly fights infections by producing phagocytes and lymphocytes, two types of protective white blood cells.
Most health problems associated with the spleen involve the spleen becoming enlarged — and when this happens, the risk for a “ruptured spleen” also goes up. Like some of our other digestive system organs, including the liver and gallbladder, the spleen is especially vulnerable to the effects of various “toxins” or parasites entering the body, along with chemicals we take in from drugs, even some medications and prescriptions.
The spleen is prone to becoming easily overworked when liver function is poor, and surprisingly some believe the spleen is usually more likely to develop problems when your diet is “damp, cold and raw.” Traditional systems of medicine, including Ayurvedic medicine, believed that a cold or damp environment, eating too many salty or sour foods, overexerting yourself, and poor digestion all make someone more susceptible to spleen and liver damage. (3)
The results of a suffering spleen? An enlarged, malfunctioning spleen can lead to frequent infections; low energy; anemic symptoms; changes in appetite, body weight, digestion and blood flow; and more. If you want to maintain a strong immune system, avoid becoming sick, and retain muscle and joint health into older age, then you want to be careful to take good care of your entire lymphatic system, including, of course, your spleen!
Since symptoms can sometimes be nonexistent, or at least minimal enough to not cause any concerns, an enlarged spleen is usually first discovered during a routine physical exam, catching most people by total surprise. Normally in adults, doctors can’t feel the spleen when it isn’t enlarged, so if they press below the rib cage during an exam and notice a swollen spleen, it points to the fact that something isn’t right.
In a healthy person, the normal weight and size of the spleen can vary a lot depending on factors like age, sex, body weight and body surface area. For example, studies suggest that the spleen can range from 58 grams in a 79-year-old woman to 170 grams in a 20-year-old man. An enlarged spleen that isn’t normal for someone’s body type and age can possibly signify the presence of disease, a virus, cognitive disorders or other issues (although this isn’t always the case, so don’t get alarmed just yet!).
Enlarged spleen symptoms can include:
- indigestion or feeling uncomfortable when eating, especially after a large meal
- spleen pain and tenderness, usually on the upper left side of the abdomen
- pain that has spread from the abdomen to the left shoulder
- spleen pain when taking deep breaths or moving around
- low energy levels, possibly even chronic fatigue
- symptoms of jaundice (including yellowing of the skin)
- symptoms of anemia (4)
- unexplained weight loss
- frequent infections (such as ear, urinary tract, respiratory or sinus infections)
- bleeding and bruising easily
Unfortunately, one of the side effects of a damaged spleen is becoming more susceptible to illnesses and feeling very fatigued. That’s because normally the spleen works as part of the body’s natural “drainage network,” producing protective white blood cells and carrying waste and bacteria away from the body. The spleen produces white blood cells that capture and destroy bacteria, dead cells and tissue, and other outside particles that make their way into the body and circulate via the bloodstream.
As blood filters through the spleen, it’s cleaned, and threatening microbes are engulfed and filtered out. Without the spleen working properly, we can’t maintain red and white blood cells we need for ongoing energy or produce enough platelets that are required for blot clotting.
The spleen can become swollen for a lot of different reasons, some more concerning than others. For example, viral infections, high alcohol intake, cirrhosis of the liver and parasitic infections are all risk factors for an enlarged spleen. Some of the ways you can prolong the health of your spleen include avoiding a poor diet high in processed foods, limiting the amount of over-the-counter or prescription drugs you take, which helps cleanse the liver, only drinking alcohol in moderation, and quitting smoking or ever using recreational drugs.
Enlarged spleen causes include:
- Bacterial infections
- Alcohol or drug use
- Inflammation related to a diet high in chemicals, preservatives, pesticides and other toxins
- Cancer that has spread
- Liver disease or cirrhosis
- Blood diseases characterized by abnormal blood cells
- Disorders of the lymph system
- Autoimmune reactions and disorders, such as arthritis
- Physical trauma to the spleen or an injury (such as a sports injury)
One of the most likely causes of an enlarged spleen is an infection, since swelling in the spleen signifies an increase in white blood cells that are trying to attack something threatening. Infections that can impact the spleen include viruses like mononucleosis, parasitic infections or infections caused by bacteria.
Leishmaniasis, a type of parasitic disease found in parts of the tropics, subtropics and southern Europe, can lead to an enlarged spleen. Leishmaniasis is believed to affect about 200,000–400,000 people every year and develops after coming into contact with parasites, including infected sand flies. Symptoms can remain “silent” or can cause skin sores, ulcers, weight loss, fever and pain, in addition to swollen lymph nodes and an enlarged spleen and liver.
Other types of parasites that can lead to enlarged spleen include: malaria, toxoplasmosis, viscera larva migrans and schistosomiasis. (5) If these are possible causes of your condition — for example, because you traveled to another continent and might have been bitten by an infected insect — your doctor will work with you to specifically treat symptoms and stabilize you before problems can worsen.
Cancer is another reason that someone can suffer spleen problems, especially leukemia (cancer of the white blood cells that take over normal healthy cells) or lymphoma (cancer of the lymph tissue). Drugs and alcohol are capable of causing problems in the spleen because they directly affect how splenic cells work. Drugs provoke severe hemolysis, which is the rupture or destruction of red blood cells. This is associated with decreased immune function and splenomegaly.
Sometimes the spleen is damaged or enlarged because of side effects or disturbances in other organs, such as the liver or other parts of the immune system. (6) For example, an enlarged spleen can develop because the liver becomes congested and overworked (resulting in liver disease in some cases), trying hard to usher toxins out the body as quickly as possible, but becoming overwhelmed in the process. (7)
How to Diagnose and Treat an Enlarged Spleen
If your doctor suspects an enlarged spleen because he or she feels something unusual during a physical, your doctor might decide to further investigate by using imaging tests, blood tests and other ways to assess how enlarged the spleen has become. Sometimes an ultrasound or computerized tomography (CT) test will be done.
If your health care provider suspects you might be infected with a parasite, your physician look for symptoms like a fever or skin rash and access blood counts (including a low red blood cell count causing anemia and low white blood cell count) since infected patients usually experience both. Your doctor will work with you to tackle the root causes of the enlarged spleen, since left unmanaged this condition can become very serious and even deadly in some cases.
Treatment options for dealing with an enlarged spleen are usually aimed at reducing any noticeable symptoms and pain, while also tackling the underlying causes like a chronic disease, diet, lifestyle, infection and so on. Only as a last resort would a doctor decide to perform surgery to remove an enlarged spleen. For most people, luckily it’s possible to remove the trigger that causes an enlarged spleen before surgery becomes necessary. (8)
Remember, the spleen is necessary and important for keeping the body guarded from disease and bacterial infections, so removing it comes with risks of its own. After surgery to remove the spleen, further down the line someone can become more prone to infections and becoming sick since removing the spleen means the body is left with one less line of defense.
Fortunately, there are a number of ways you can help protect yourself from developing or worsening an enlarged spleen.
1. Protect the Spleen from Rupturing
Anyone who has an enlarged spleen should be careful to avoid any type of rough contact, especially near the abdomen, since this can cause a ruptured spleen. This means avoiding contact sports (like football, basketball, wrestling, hockey, etc.) and limiting any type of physical activity where the spleen can become further damaged.
An important precaution to take is to always wear a seat belt when driving, since a car accident is likely to cause even more injury to the spleen. Remember that not every case of an enlarged spleen is problematic, so find out from your doctor first what types of activities you’re cleared to do.
2. Eat a Nutrient-Dense Diet
Historically in Eastern medicine, the spleen is viewed as one of the most important organs to well-being, strength and immunity. That’s because it’s more than just a guardian and organ capable of managing blood cells — the spleen also helps turn nutrients from digested foods into useable fuel.
In Ancient Chinese Medicine and other schools of Eastern medicine, an unhealthy spleen is one of the key contributors to fatigue and anemia, and it can impact how other digestive organs work, including the colon, uterus, rectum, liver or stomach.
The best way to support your spleen and entire lymphatic and digestive systems is to eat a diet high in antioxidants, vitamins, minerals and essential fluids. This helps lower inflammation and fight free radical damage that can make an enlarged spleen turn into a worsened problem.
A healthy diet can benefit the entire body, including the spleen, which will work more efficiently to carry blood cells and nutrients to tissue, while also removing waste, when you obtain plenty of nutrients. A diet high in plant foods also helps provide enough hydrating water, which is important for helping the spleen rid itself and the body of excess fluids and foreign matter.
Try to avoid eating foods that place stress on your circulatory and immune systems. The more chemicals you obtain through the foods your eat, the more work your liver, spleen and other organs have to do. Foods to limit or eliminate from your diet include: common allergens (like dairy products, gluten, soy, shellfish or nightshades, for example), low-quality animal products, sugary snacks, refined vegetable oils (canola, corn, safflower, sunflower and soybean) and processed foods that contain chemical sprays or toxins.
Some of the key anti-inflammatory foods to load up on include:
- green leafy vegetables
- brightly colored fruits and veggies of all kinds, including cruciferous veggies (broccoli, cabbage, cauliflower, etc.) and berries
- lean proteins, especially omega-3 foods like salmon and wild seafood
- nuts and seeds (chia, flax, hemp, pumpkin, etc.)
- unrefined oils like extra virgin olive oil and coconut oil
- herbs, condiments and spices (ginger, capsicum, molasses, turmeric, garlic, for example)
3. Move Your Body
Drainage of the lymphatic system depends heavily on you moving your body regularly. While lymph fluid can move through the lymph nodes and spleen somewhat on its own thanks to gravity and blood circulation, you’re much more prone to illness and swelling when you’re stagnant. Regularly exercising benefits your spleen because it helps keep blood flowing and fluids moving through your body. This is important considering the spleen is responsible for the filtering and transformation of particles within lymph fluids. (9)
Exercise increases blood flow to your digestive organs and engages muscles in your digestive tract, so once the spleen and liver do their jobs to clean the body, more movement further helps usher out waste. Following exercise with foam rolling, massage therapy or infrared sauna treatments is also beneficial for supporting the lymphatic system and helping with detoxification.
4. Reduce Stress
Your lymphatic, immune and digestive systems are all vulnerable to the effects of stress. Your brain communicates with organs around your entire body, and every time it suspects that you’re in a threatening situation, hormones are altered that affect your body’s ability to defend itself from threats.
Chronic stress can weaken the immune system and cause inflammation, digestive problems like irritable bowel syndrome, ulcers and much more. (10) To help combat high amounts of stress, make it a priority to try relaxing exercises like being more active, doing hobbies you love, spending time in nature, taking warm baths, breathing exercises and so on.
5. Try Supplements that Support Lymphatic
Several essential oils are beneficial for improving the body’s ability to drain swelling, fight infections, increase blood flow and reduce pain. Essential oils that are useful for targeting swelling in the lymph nodes include lemon, myrrh, oregano, cypress and frankincense oils.
Combine several drops with a carrier oil like jojoba or coconut oil, and massage them over the spleen two to three times per day. Other supplements that can help improve liver health, circulation and fight inflammation include: omega-3 fish oils, turmeric, burdock root, digestive enzymes, activated charcoal and milk thistle.
Laparoscopic Splenectomy NJ – Spleen RemovalStephen G. Pereira, M.D.
New Jersey Spleen Removal (Splenectomy)
WHAT IS THE SPLEEN?
The spleen is a blood filled organ located in the upper left abdominal cavity. It is a storage organ for red blood cells and contains many specialized white blood cells called “macrophages” (disease fighting cells) which act to filter blood. The spleen is part of the immune system and also removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria. The spleen can affect the platelet count, the red blood cell count and even the white blood count.
HOW DO I KNOW IF MY SPLEEN SHOULD BE REMOVED?
There are several reasons why a spleen might need to be removed, and the following list, though not all inclusive, includes the most common reasons. The most common reason is a condition called idiopathic (unknown cause) thrombocytopenia (low platelets) purpura (ITP). Platelets are blood cells which aid is blood clotting. Hemolytic anemia (a condition that breaks down red blood cells) requires a spleen removal to prevent or decrease the need for transfusion. Also, hereditary (genetic) conditions that affect the shape of red blood cells, conditions known as spherocystosis, sickle cell disease or thalassemia, may require splenectomy. Often patients with cancers of the cells which fight infection, known as lymphoma or certain types of leukemia, require spleen removal. When the spleen gets enlarged, it sometimes removes too many platelets from your blood and has to be removed. Sometimes the spleen is removed to diagnose or treat a tumor. Sometimes the blood supply to the spleen becomes blocked (infarct) or the artery abnormally expands (aneurysm) and the spleen needs to be removed.
HOW ARE THESE PROBLEMS FOUND?
An evaluation typically includes a complete blood count (CBC), a visual look at the blood cells placed on a glass slide called a ‘smear’, and often a bone marrow examination. Sometimes an ultrasound examination of your spleen, a computerized tomography (CT scan), magnetic resonance imaging (MRI) or nuclear scan is needed.
WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC SPLENECTOMY?
Results may vary depending on your overall condition and health. Usual advantages are:
- Less postoperative pain
- Shorter hospital stay
- Faster return to a regular, solid food diet
- Quicker return to normal activities
- Better cosmetic results
AM I A CANDIDATE FOR LAPAROSCOPIC SPLEEN REMOVAL?
Most patients can have a laparoscopic splenectomy. Though the experience of Dr. Pereira is a big factor in a successful outcome, the size of the spleen is the most important determinant in deciding whether the spleen can be removed laparoscopically. When the size of the spleen is extremely large, it is difficult to perform the laparoscopic technique.
Sometimes, plugging the artery to the spleen right before surgery using special X-ray technology can shrink the spleen to allow the laparoscopic technique. You should obtain a thorough evaluation by a surgeon qualified in laparoscopic spleen removal along with consultation with your other physicians to find out if this technique is appropriate for you.
WHAT PREPARATION IS REQUIRED?
- After Dr. Pereira reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
- Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
- Immunization with a vaccine to help prevent bacterial infections after the spleen is removed should be given two weeks before surgery, if possible.
- Blood transfusion and/or blood products such as platelets may be needed depending on your condition.
- Dr. Pereira may request that you completely empty your colon and cleanse your intestines prior to surgery. You may be requested to drink clear liquids, only, for one or several days prior to surgery.
- It is recommended that you shower the night before or morning of the operation.
- After midnight the night before the operation, you should not eat or drink anything except medications that Dr. Pereira has told you are permissible to take with a sip of water the morning of surgery.
- Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
- Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
- Quit smoking and arrange for any help you may need at home.
HOW IS LAPAROSCOPIC REMOVAL OF THE SPLEEN DONE?
You will be placed under general anesthesia and be completely asleep. A cannula (hollow tube) is placed into the abdomen by Dr. Pereira and your abdomen will be inflated with carbon dioxide gas to create a space to operate. A laparoscope (a tiny telescope connected to a video camera) is put through one of the cannulas which projects a video picture of the internal organs and spleen on a television monitor. Several cannulas are placed in different locations on your abdomen to allow Dr. Pereira to place instruments inside your belly to work and remove your spleen. A search for accessory (additional) spleens and then removal of these extra spleens will be done since 15% of people have small, extra spleens. After the spleen is cut from all that it is connected to, it is placed inside a special bag. The bag with the spleen inside is pulled up into one of the small, but largest incisions on your abdomen. The spleen is broken up into small pieces (morcelated) within the special bag and completely removed.
WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE LAPAROSCOPIC METHOD?
In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.
The decision to perform the open procedure is a judgment decision made by Dr. Pereira either before or during the actual operation. When Dr. Pereira feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.
WHAT CAN I EXPECT AFTER SURGERY?
After surgery you will be given intravenous fluids (IV’s) in your arm. You may have a stomach tube coming up out your nose to prevent vomiting or stomach bleeding because your stomach can fill up with stomach juices and not empty properly after this surgery. Not every surgeon uses this tube. You will be given pain medication to relieve the discomfort you may experience from the small incisions. You will need to let your nurse and surgeon know what your pain medication needs are since everyone has a different pain threshold.
As soon as you can resume oral intake, urinate, and care for your basic needs, you will typically be able to go home. Dr. Pereira will tell you when it is safe to go home.
Typically, once you have gone home, you may do the following, but each situation differs and “at home” activities should be discussed with your doctor.
- Activity: You can walk and go up stairs. You can shower, but most surgeons prefer that you do not soak in a tub for at least a week or more after surgery. When you feel stronger ask Dr. Pereira about more strenuous activities.
- Driving: Ask Dr. Pereira. Most people can resume driving 5 to 7 days after surgery. You should not be taking pain medication when you drive.
- Diet: Unless you have special dietary needs, such as diabetes, you can eat a normal diet at home.
- Bowel function: It is common to get constipated after surgery, especially when you are taking pain medication. It is important to drink plenty of water and take in enough fiber in your diet. Dr. Pereira may advise you about means to help your bowel function postoperatively. Ask or call Dr. Pereira before taking a cathartic.
WHAT COMPLICATIONS CAN OCCUR?
Complications following laparoscopic splenectomy are infrequent, but you should consult your doctor regarding possible complications based on your specific case. Possible complications may include cannula site infections, pneumonia, internal bleeding or infection inside the abdomen at the site where the spleen used to be, although these complications are infrequent. The pancreas can become inflamed (pancreatitis). Problems that can occur a few months to years later are hernias at the cannula sites or overwhelming infection throughout the entire body. This complication is also infrequent. Overwhelming infection that occurs after splenectomy is called OPSI or Overwhelming Post-Splenectomy Infection. OPSI is a result of not having a spleen to fight certain bacterial infections. Immunization is usually given before you have your spleen removed and is one method to help the body fight and prevent infection. Antibiotics, like penicillin, can be given if an infection develops because the bacteria that commonly cause this type of infection are very sensitive to antibiotics. It is important that you tell your physician or any physician that is covering for your doctor that you had your spleen removed.
WHEN TO CALL
Be sure to call Dr. Pereira if you develop any of the following:
- Persistent fever over 101 degrees F (39 C)
- Increasing abdominal swelling
- Pain that is not relieved by your medications
- Persistent nausea or vomiting
- Persistent cough or shortness of breath
- Purulent drainage (pus) from any incision
- Redness surrounding any of your incisions that is worsening or getting bigger
- You are unable to eat or drink liquids
Have Questions? Call (201) 343-3433 or request an appointment online.
What Does the Spleen Do?
“Must I observe you? must I stand and crouch
Under your testy humour? By the gods
You shall digest the venom of your spleen”
William Shakespeare, Julius Caesar
For centuries, writers like Shakespeare and many other poets, philosophers, and scientists associated the spleen with an uneasy disposition or a foul temperament. It was thought to secrete a black substance that would negatively affect personality and mood. The term “splenetic personality” was used hundreds of years ago to refer to a person who was irritable or otherwise bad-tempered.
Modern science, of course, has learned much about the human body’s function since then, but the spleen remains a somewhat mysterious organ for most people. So the question is: what does the spleen do?
In the most basic terms, the spleen filters our blood. Located under the rib cage and behind the stomach, the spleen is the largest organ in the lymphatic system and plays an important role in the healthy function of our immune system. By filtering out toxins and cellular waste in conjunction with the circulatory system, the spleen and lymph nodes are critically important for preventing disease and fighting infections.
The spleen does the majority of its work by regulating the number of red blood cells found in our blood. Additionally, this versatile organ stores the platelets that are necessary for blood clots to form in the event of injury, for example. Keeping the number of red blood cells and platelets consistent is important for healthy function; a healthy spleen will allow blood to efficiently carry oxygen to all parts of the body and be at the ready if injury or disease is detected.
The other related and important function of the spleen is to store white blood cells. White blood cells stored in the spleen are called lymphocytes, and they are one of the body’s primary defenses against various diseases and infections. When the body detects an infection, these lymphocytes are released into the bloodstream and seek out dangerous elements and eliminate them.
Conditions Related to the Spleen
Enlarged spleen (splenomegaly): An enlarged spleen can have many different causes, but it is typically due to an underlying condition which leads to either overwork of the organ or an excess of cellular material. One of the most common causes is the overproduction of red blood cells in bone marrow.
Ruptured spleen: A spleen can become ruptured if the body is exposed to an extreme contact injury. Depending on the severity of the injury, the spleen can burst on contact or result in internal bleeding. Some conditions, like mononucleosis or malaria, can increase the likelihood of a spleen rupture by contributing to splenomegaly.
Thrombocytopenia: This condition is defined by a reduced platelet count in the blood. This can occur if the spleen is enlarged due to a buildup of platelets, and it can result in fewer platelets being available for blood clotting functions.
Sickle cell disease: This set of disorders is largely a genetically inherited condition that affects the hemoglobin in red blood cells; in turn, the affected hemoglobin disrupts cells’ ability to transport oxygen throughout the body. When that happens, several organs including the spleen, can become damaged.
Spleen cancer: Though somewhat rare, spleen cancer can either originate in the spleen or be carried there through metastasization. It is sometimes related to other lymphatic system cancers such as leukemia and lymphoma.
Splenic infarction: In situations where blood flow to the spleen is reduced or interrupted, splenetic infarction can occur. It is during this interruption of blood flow that can cause the spleen to be damaged and negatively affect future function.
Symptoms and Causes of an Enlarged Spleen
One of the most common conditions related to the spleen is splenomegaly, an enlarged spleen.
Most of the time an enlarged spleen is the result of an underlying problem, so the symptoms will likely present in similar ways as other health issues. You won’t be able to feel your spleen being larger nor specific pain or discomfort in the area, so you’ll have to be aware of some typical symptoms that might point to a problem:
- Easily bleeding from even minor injuries.
- Feeling tired or easily fatigued.
- An increase in the number of infections you have.
- A feeling of being full without having eaten (due to the enlarged spleen putting physical pressure on your stomach).
- Pressure or mild pain on the left side of your abdomen or even up to your left shoulder.
There are many different potential causes of an enlarged spleen, including viral and bacterial infections, cirrhosis, anemia, cancer of the blood like Hodgkin’s disease, and some metabolic disorders. Since the spleen is so central to immune system health, recognizing symptoms and finding the underlying cause is critically important to your overall health and wellbeing.
Maintaining Spleen Health
Like most other components of medical health, an overall healthy lifestyle is important for maintaining a healthy spleen. Proper diet and regular exercise are important factors in helping your spleen continue to filter toxins and replace damaged red and white blood cells and platelets.
Some people, unfortunately, have genetic conditions (such as sickle cell disease) or other health complications which make spleen problems more likely. For those conditions, it is important to have regular annual visits to a doctor to track any potential for problems.
Since one of the most frequent spleen problems is an enlarged spleens, there are a variety of measures that can be taken to prevent splenomegaly and related conditions:
- Avoid sharing utensils or objects that interact with mucous membranes with anyone who is infected with mononucleosis.
- Wear proper protective gear for any sporting activities that might lead to contact injuries.
- Always use proper protection when engaging in sexual activity with a new partner.
- Drink alcohol in moderation to maintain liver health and decrease the likelihood of developing cirrhosis.
Can You Live Without a Spleen?
While the spleen plays a number of important functions in general health and the efficient functioning of the immune system, it is still possible to live without a spleen. As a result of many of the conditions listed above, there are times when it can become necessary to remove the spleen for the patient’s long term health.
This procedure, referred to as a splenectomy, is typically used to remove a spleen that has ruptured, either due to complications from an infection or an injury. The surgery can be done laparoscopically by a skilled surgeon to avoid an unnecessarily invasive operation. In some cases the procedure can be elective (in consultation with your doctor) in order to preempt potential future complications.
Once the spleen has been removed, the rest of the lymphatic system and the liver will take over the function of the former spleen. Those who have had their spleen removed can still live healthy lives, but they are consequently more susceptible to some diseases and therefore must be more conscious of those related complications.
The spleen is a small organ that isn’t popularly understood, but it plays a vital role in our everyday health and wellbeing. By filtering and regulating red blood cells, white blood cells, and platelets, the spleen is an important factor in the function of the lymphatic system in overall immune system health.
By having a better understanding of how our spleens function, you will be able to make better health choices.
If you have experienced some of the symptoms discussed here and want more information, contact Gastroenterology Consultants of Savannah to make an appointment. We have several convenient locations and a helpful staff that is dedicated to providing excellent healthcare.
The Strange History Of The Spleen, The Organ That Can Replicate Itself : Shots
The spleen, shown in the 19th-century French anatomy atlas, Traite Complet de L’Anatomie de L’Homme.
The spleen, shown in the 19th-century French anatomy atlas, Traite Complet de L’Anatomie de L’Homme.
On a crisp New England fall day, college freshman Jordan Taylor was playing Ultimate Frisbee when he collided with another player. Taylor was rushed to the hospital, where doctors realized he’d been hit hard enough to tear the delicate covering of his spleen, and he was bleeding internally. A quick surgery fixed the spleen, but doctors saw something strange while they were operating.
“As the doctor was speaking to me post-surgery, he mentioned he’d noticed I had a bunch of extra spleens,” Taylor says. We asked if the additional organs gave him spleeny superpowers.
No, alas. But “now I have a pretty good fun fact for when I meet new people,” he says. “Never fails to get a follow-up question.”
Beyond that, Taylor says, he goes about his days the same ways he always has. He tries not to think about his extra spleens too much. They sort of gross him out.
Spleens are strange organs, located on the upper-left side of the abdomen behind the stomach. They’re about the size and shape of an orange wedge, if the orange was squishy and full of blood. They’re relatively fragile, and because they contain so much blood, injuries can become serious.
A very informal poll of NPR employees, friends and random Uber drivers reveals that most people don’t have any idea what spleens are for. If they did know anything about spleens, it was this: You don’t need one to live.
The deep red, squishy spleen has been relegated to the organ bargain-basement, something to be cut out and discarded along with the appendix and wisdom teeth. But the spleen is seriously underrated, and we would like to give it a chance to redeem itself.
In ancient Greek and medieval humoral medicine, few body parts were more crucial than the spleen. People believed that the spleen was responsible for making “black bile,” one of the four humors that needed to be kept in balance to stay healthy. If a spleen made too much black bile, it would make someone sad or depressed. But the spleen also cleansed the bile, so it was associated with happiness and laughter.
Because the spleen was so important, it squirmed its way into modern language, says Alisha Rankin, an associate professor and medical historian at Tufts University. Poems were written about the organ, and 19th-century women with depression were said to be plagued by spleen.
“It’s funny — in English, the spleen has a dual function. If you have dark and angry thoughts, you can be splenetic or vent spleen. But you can also bust a spleen laughing,” says Rankin.
So when Shakespeare’s King Richard III tried to rally his troops by shouting, “Fair St. George, inspire us with the spleen of fiery dragons!” we can only assume that his army was motivated and won the battle (spoiler alert: it didn’t).
The spleen reigned supreme for several centuries. But eventually, says Rankin, Louis Pasteur discovered bacteria and Alexander Fleming found penicillin. Doctors realized that black bile and imbalanced humors didn’t make you sick — germs did. No longer responsible for our joy or sorrow, the spleen fell into obscurity.
And for over a century, that’s where it stayed.
“Up until the 1950s, nobody knew what the spleen was for. We thought it didn’t matter,” says Dr. David Shatz, a surgical critical care specialist at the University of California, Davis, whose research focuses on spleen trauma.
We know that while you’re still a fetus, the spleen makes red blood cells. And as an adult, the spleen acts as a garbage can, filtering out damaged blood cells and platelets. But you can live with some old broken blood cells, so if you injured your spleen in the 1950s, doctors wouldn’t waste time trying to stitch it up. They’d cut it out in a splenectomy and send you on your way.
But modern imaging technology has left us with a different picture of the spleen, realizing that it has a role in the immune system. Blood slows down as it passes through the spleen, which gives the immune system time to recognize and make antibodies for certain types of bacteria.
“It processes encapsulated bacteria — ones that cause meningitis and ones that cause pneumonia,” says Shatz. Without the spleen to keep these bacteria in check, about 0.5 percent of people who have their spleens removed develop sepsis, a potentially deadly blood infection.
“It’s not very common, but it’s common enough to be a problem,” says Shatz. Generally, doctors try to reduce the risk of sepsis with vaccination for pneumococcus, H. influenzae type B (Hib), and meningococcus, so patients’ immune systems can recognize these bacteria without a spleen’s assistance.
But not everyone gets those vaccinations, so some doctors have tried other tactics. Because it turns out that spleens can do something no other organ can: They can make more of themselves.
Remember Taylor and his extra spleens? When a spleen is injured, cells from the organ scatter throughout the abdomen. If the cells are lucky enough to land somewhere with a lot of blood vessels, they start to grow into tiny extra spleens called splenunculi. The whole process is called splenosis, and it seems to be pretty common: about 1 in 5 people have accessory spleens. It’s likely Taylor had had a minor spleen injury earlier on in his life — not enough to need a doctor, but enough to release spleen cells.
“As far as we know, the spleen is the only organ that can do this,” says Shatz. Even livers, with their impressive regenerative powers, can’t replicate like a spleen.
To reduce the rates of post-splenectomy sepsis, some doctors have tried to deliberately make accessory spleens. Instead of removing a spleen entirely, they’ve cut spleens up into tiny pieces and left the bits inside patients to grow. Studies have also been done in animals, and according to Shatz, the procedure was fairly side-effect-free.
Unfortunately, it’s hard to tell whether these accessory spleens have any real benefit. Although the spleen-bits attached and grew, only a handful of cases were looked at, so it’s hard to tell whether the new spleens did their jobs as well as their full-sized counterparts — or better than no spleen at all.
Shatz hopes to one day do a large clinical trial. “We’ll assign a random number; some spleens will get cut up, and some spleens will go in a bucket.” But it hasn’t been a research priority, says Shatz. Spleens are cool, but they’re not critical.
In the meantime, cheers to the spleen, an underappreciated but impressive organ, filtering away whether you need it to or not. Count your blessings (or count your spleens), and if you aren’t in the 18.8 percent with spare splenunculi, don’t whine about it. Or, as my dad would say, “don’t get spleeny.”
Spleen problems and spleen removal
Some people are born without a spleen or need to have it removed because of illness or injury.
The spleen is a fist-sized organ 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 some important functions:
- it fights invading germs in the blood (the spleen contains infection-fighting white blood cells)
- it controls the level of blood cells (white blood cells, red blood cells and platelets)
- it filters the blood and removes any old or damaged red blood cells
The spleen is not working properly
If the spleen does not 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, caused by a reduced number of platelets
A painful spleen
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 burst (rupture) after an injury, such as a blow to the abdomen, a car accident, a sporting accident or broken 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, you can feel the pain at the tip of your left shoulder.
A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding.
Go straight to A&E if you think you have ruptured or damaged your spleen.
An enlarged spleen
The spleen can become swollen after an infection or injury. It can also become enlarged as a result of a health condition, such as cirrhosis, leukaemia or rheumatoid arthritis.
An enlarged spleen does not 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 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 can 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. You may be prescribed antibiotics 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’s enlarged.
Surgery is only necessary if the enlarged spleen is causing serious complications or the cause cannot be found.
Surgery to remove the spleen
You may need an operation to remove your spleen, known as a splenectomy, if it’s not working properly or it’s damaged, diseased or enlarged.
Sometimes just part of your spleen can be removed, which is called a partial splenectomy.
If there’s time, you’ll be advised to have certain vaccinations before the operation. This is because spleen removal weakens your immune system and can make you more likely to get an infection.
Most operations to remove spleens are carried out using keyhole surgery (laparoscopy).
Keyhole spleen removal allows a surgeon to get inside your tummy (abdomen) to your spleen without having to make large cuts.
This means you’ll have less scarring and may recover from the operation more quickly. But you’ll still need a general anaesthetic.
The procedure involves:
- making several small cuts in your tummy
- guiding a laparoscope into your body through one of the cuts so doctors can see what they’re doing
- passing thin instruments into your tummy through the other cuts to remove your spleen (gas will be pumped into your tummy to make this easier)
The cuts 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 is where one large cut is made. It may be needed if your spleen is too large or too damaged to be removed using keyhole surgery. Often, in emergencies, this is the preferred method.
You’ll need a general anaesthetic and may need to stay in hospital for a few days to recover.
Recovering from spleen surgery
It’s normal to feel sore and be bruised after a splenectomy, but you’ll be given pain relief.
You should be able to eat and drink as normal soon after the operation.
Like any operation, spleen removal carries a small risk of complications, including bleeding and infection.
Your doctor will talk through these risks with you.
You should be given breathing and leg 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’ll still be able to cope with most infections. But there’s a small risk that a serious infection may develop quickly. This risk will be present for the rest of your life.
Young children have a higher risk of serious infection than adults, but the risk is still small.
The risk is also increased if you have a health condition like sickle cell anaemia or coeliac disease, or a health condition that affects your immune system, like HIV.
This risk can be minimised by following simple precautions to prevent infection.
Check with your GP surgery that you have had all your routine NHS vaccinations.
You should also be vaccinated against:
- pneumococcal infections, such as pneumonia, with a booster every 5 years
- flu (get the flu vaccine every year)
It’s recommended that you take low-dose antibiotics for the rest of your life to prevent bacterial infections.
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 does not work properly
Be alert for signs of infection
See a GP as soon as possible if you get signs of an infection.
Signs of infection include:
- a high temperature
- a sore throat
- a cough
- a severe headache
- a headache with drowsiness or a rash
- abdominal pain
- redness and swelling around the surgical wound
Your GP can prescribe a course of antibiotics for you to use if you get an infection.
If your infection becomes serious, you may be admitted to hospital.
Beware of animal and tick bites
Bites from animals and small blood-sucking parasites called ticks can cause infections.
If you get bitten by an animal, particularly a dog, start your course of antibiotics if you have them with you, and seek medical advice urgently.
If you go trekking or camping regularly, you may be at risk of Lyme disease, a disease transmitted 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.
Tell medical staff about your spleen problems
Healthcare professionals will mark your health records to show that you do not have a working spleen.
But always remember to tell any medical professionals that you see, including your dentist.
Carry medical ID
It’s a good idea to carry or wear some medical ID.
- 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 staff to your condition.
If you’re travelling abroad:
- you may be advised to take a course of antibiotics with you
- check if you need any travel vaccinations
People without a working spleen have an increased risk of developing a severe form of malaria.
If possible, avoid countries where malaria is present. If you cannot avoid them, speak to a GP or local pharmacist about antimalarial medicine before you travel.
You should also use mosquito nets and insect repellent.
Page last reviewed: 03 May 2019
Next review due: 03 May 2022
Spleen – Better Health Channel
The spleen is located on the left side of the abdomen and weighs around 200 g in the average healthy adult. The spleen can be considered as two organs in one. It filters the blood and removes abnormal cells (such as old and defective red blood cells), and it makes disease-fighting components of the immune system (including antibodies and lymphocytes).
Since the spleen is involved in so many bodily functions, it is vulnerable to a wide range of disorders. However, the human body adapts well to life without this organ, so surgically removing a diseased or damaged spleen is possible without causing any serious harm to the person.
The body of the spleen appears red and pulpy, surrounded by a tough capsule. The red pulp consists of blood vessels (splenic sinusoids) interwoven with connective tissue (splenic cords). The red pulp filters the blood and removes old and defective blood cells. The white pulp is inside the red pulp, and consists of little lumps of lymphoid tissue.
Antibodies are made inside the white pulp. Similarly to other organs of the lymphatic system, particular immune cells (B lymphocytes and T lymphocytes) and blood cells are either made or matured inside the spleen. Blood enters the spleen via the splenic artery, which subdivides into many tiny branches. Each branch is encased in a clump of lymphocytes, which means every drop of blood is filtered for foreign particles as it enters the spleen.
Disorders of the spleen
Some of the disorders that can affect the spleen include:
- splenic rupture.
A variety of disorders can cause the spleen to enlarge, sometimes to 2kg or more. Any conditions that cause a rapid breakdown of blood cells, such as haemolytic anaemias, can place great strain on the spleen and make it enlarge. Other causes of splenomegaly include infections (such as glandular fever), liver disease and some cancers (such as Hodgkin’s disease, leukaemia and lymphoma).
The two characteristic features of hypersplenism are splenomegaly and a deficiency of one or more blood components. It seems that an enlarged spleen is sometimes overactive and will destroy more blood cells than necessary. Symptoms depend on which blood component is lacking. For example, if red blood cells are deficient, anaemia will be the result (with symptoms including fatigue and pallor). Most cases of hypersplenism are caused by disorders somewhere else in the body, such as cirrhosis of the liver.
Certain disorders, including glandular fever, can occasionally make the enlarged spleen delicate enough to spontaneously rupture. A sudden blow to the abdomen can split the outer capsule of the spleen and cause bleeding into the abdominal cavity. There are various degrees of splenic rupture. When bleeding is life threatening, surgery to remove the spleen (splenectomy) is needed.
Diagnosis of spleen disorders
Depending on the condition under investigation, disorders of the spleen can be diagnosed using a number of tests, including:
- physical examination
- blood tests
- computed tomography (CT) scan
- bone marrow biopsy
- other tests to check for underlying disorders.
Treatment for spleen disorders
Treatment depends on the disorder and its specific cause. For example, if the splenomegaly is caused by particular cancers (including Hodgkin’s disease, leukaemia or lymphoma), then treatment will focus on eliminating or controlling the primary disease. Hypersplenism, triggered by cirrhosis of the liver, can be treated with abstinence from alcohol and special dietary modifications. A severely ruptured spleen is usually surgically removed.
Recovery after splenectomy
The surgical removal of the spleen is called a splenectomy. The body can cope without the spleen, although the person might be more susceptible to infections after the operation. Their blood may also contain odd-shaped red blood cells. In some cases, it is possible to remove only the diseased or damaged parts of the spleen. This allows the remaining healthy portions to keep functioning as normal.
Immunisations and splenectomy
People who have had their spleen removed or have a spleen disorder are at increased risk of infection, most commonly pneumococcal infection.Some vaccines are recommended especially for these people and they should be discussed with the doctor.They are:
- pneumococcal vaccine
- meningococcal vaccines
- haemophilus influenzae type b vaccine (recommended in an adult who has close contact with children less than 5 years of age).
Where to get help
- Your doctor
- Alfred Hospital – Victorian Spleen Registry (03) 9076 3828
A Medical Enigma, Its Natural History and Rationalization
World J Surg. 2013; 37(3): 545–550.
History of Medical Sciences, Poznan University of Medical Sciences, ul. Przybyszewskiego 37A, 61-111 Poznan, Poland
History of Medical Sciences, Poznan University of Medical Sciences, ul. Przybyszewskiego 37A, 61-111 Poznan, Poland
Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
This article has been cited by other articles in PMC.
Wandering spleen is a rare condition in which the spleen is not located in the left upper quadrant but is found lower in the abdomen or in the pelvic region because of the laxity of the peritoneal attachments. Many patients with wandering spleen are asymptomatic, hence the condition can be discovered only by abdominal examination or at a hospital emergency department if a patient is admitted to hospital because of severe abdominal pain, vomiting or obstipation.
This article aims to provide a historical overview of wandering spleen diagnostics and surgical treatment supplemented with an analyses of articles on wandering spleen included in the PubMed database.
One of the first clinical descriptions of a wandering spleen was written by Józef Dietl in 1854. The next years of vital importance are 1877 when A. Martin conducted the first splenectomy and in 1895 when Ludwik Rydygier carried out the first splenopexy to immobilize a wandering spleen. Since that time various techniques of splenectomy and splenopexy have been developed.
Introducing medical technologies was a watershed in the development and treatment of wandering spleen, which is confirmed by the PubMed database. Despite the increased number of publications medical literature shows that a wandering spleen still remains a misdiagnosed condition, especially among children.
The development of knowledge referring to wandering spleen
Ayurveda, the classical Indian system of medical practice based on the humor doctrine, describes the spleen as “the root of the ducts which transport the blood” . The ancient Greek humoral system of Hippocrates and Galen, in some ways analogous to that description, attributed to the spleen the role of an organ responsible for producing black bile, whose Greek name: μελανχολία, is the root of the English word melancholia . Over hundreds of years, doctors, strongly influenced by the legacy of the humoral theory, successfully anchored the spleen in the pathogenesis of neurasthenia and hypochondria experienced by women, whereas women’s hysteria was explained as the result of wandering of the uterus. Even when advances in the field of morbid anatomy indicated the obvious absurdity of humoral theory, doctors were unable to free themselves from these stereotypical notions. It was as late as 1682 when an outstanding English physician, Thomas Sydenham (1624–1689), provided evidence for strangulation of the womb , whereas as recently as 1863, Józef Dietl (1804–1878) , an internationally acclaimed clinical doctor, wrote that a wandering spleen led women to experience hypochondria and that a wandering uterus caused hysteria. In 1908 John Duncan  expressed his belief that wandering organs, including a wandering spleen, are an expression of neurasthenia.
In 1653, Panoralus  for the first time described the spleen as a “ductless gland”. Next, in 1667 Van Horne recognized and described the phenomenon of a wandering spleen . Even though post-mortem examinations were carried out more and more often in the seventeenth century, they did not provide any information as to how important the spleen could be for the human body. No wonder, then, that in 1725 Sir Richard Blackmore (1654–1729) , an English doctor and poet, questioned whether it is necessary to have a spleen for the human body to function normally.
In the nineteenth century the spleen still remained a medical enigma. The authors of German anatomy atlases, Robert Foriep (1804–1861), a doctor and an artist who followed Italian lithographers, and Theodor Richter (1824–1898), who was helped by a professional illustrator, did not pay much attention to the spleen. Interestingly, such a rare phenomenon as a wandering spleen kept arousing enormous interest among physicians. A wandering spleen resulted in the characteristic dullness of lung sounds on percussion and was proved by palpation. The greatest authorities in medical science widely described the diagnosis of a wandering spleen, including the Scottish doctor and philosopher John Abercrombie (1780–1844), who wrote “Researches on the Diseases of the Intestinal Canal, Liver and other Viscera of the Abdomen” (Edinburgh 1838) and the most prominent member of the Vienna School, Carl von Rokitansky (1804–1878), who described the phenomenon in the course-book “Lehrbuch der patologische Anatomie” (Textbook on Morbid Anatomy) (Vienna 1846) .
One of the first case reports of a wandering spleen in a child was published in 1854 by the Polish physician Józef Dietl (Fig. ) in the Polish journal “Pamiętnik Towarzystwa Lekarskiego Warszawskiego” (Diary of the Warsaw Medical Society) and in ”Wiener Medizinische Wochenschrift.” Two years later Dietl  included in the same periodical his next observations of a case related to a wandering spleen, yet this time he took the post mortem examination into consideration. In 1863 Dietl described a third case of a wandering spleen in “Przegląd Lekarski,” a journal he founded and edited himself. It was there that he indicated this condition to be life-threatening because it led to an extensive peritonitis and consequently death. He was one of the first doctors who stated that it was not a patients’ temperament but rather relaxation, extension, or the hypoplasia of splenic ligaments that made a spleen wander. He considered wandering spleen to be a condition present in women emaciated and exhausted by extensive work. He treated the condition by using quinine (he believed it decreased the size of the spleen and improved his patients’ mood) and an abdominal compression binder made of plain linen or rubber. Surgical removal of the spleen, recommended by Friedrich Kűchenmeister (1821–1890), was considered by Dietl  as definitely too risky. Still, he allowed the abdominal wall to be pierced with a knife in order to provoke limited inflammation and local adhesion.
Józef Dietl (1804–1878), a Polish physician who described one of the first cases of a wandering spleen in a child (by courtesy of the Polish National Digital Archives)
In his historical study of surgery, Ricketts  cited Dietl’s article published in 1863 as a classical description of clinical wandering spleen complications. This text, however, did not gain as much publicity as a clinical description of a wandering kidney incarceration on the basis of which the eponym “Dietl’s crisis” was created . By no means was it a coincidence that Dietl, who was both an internist and anatomopathologist, became interested in the symptoms of both a wandering kidney and a wandering spleen, even though in the interwar period doctors considered such symptoms a single clinical problem .
Advances in spleen surgery
Before narcosis and antiseptic treatment had been introduced, the diagnosis of a wandering and/or enlarged spleen seldom if ever became an indication for organ removal. In 1549, Adrian Zacarelli for the first time had demonstrated removal of an enlarged spleen . In the following centuries war wounds imposed on doctors the necessity for surgical treatment of the spleen. Its removal was considered necessary in cases of rupture or ulcerative stomach wounds , what in 1788 was first described by Giovanni Fantoni in “Opuscula Medica et Physiologica,” a work published in Geneva. Then, in 1855 Darmstadt, Julian Schultz completed the successful removal of a spleen protruding from a wound in the patient’s side . The first fully documented and successful removal of a wandering spleen was carried out by Martin  in 1877 in Berlin. One year later Vincenz Czerny (1840–1916), in Heidelberg, made the next successful surgical removal of a wandering spleen .
To sum up, between 1855 and 1903 doctors conducted 360 splenectomies, 38.3 % of which resulted in the patients’ death from hemorrhage and shock (Fig. ) . It is worth stressing that in 1865–1875 up to 80 % of patients died after spleen removal . Such a high mortality rate resulted from the fact that one of the first indications for splenectomy was not only an enlarged and/or wandering spleen but also evidence of leukemia . To 1900, the mortality rate among patients with a removed spleen in the treatment of leukemia amounted to 87.7 % . As late as the interwar period, all cases of splenomegaly, including conditions caused by malaria, kala-azar disease, leukemia, and anemia, or any unknown conditions, were treated by removing the spleen .
One of the first images of spleen, where it is marked as a separate organ with its own name ‘lien’, in “Anatomischer Atlas” by an Austrian anatomist Carl Toldt (1840–1920), (Berlin–Vienna 1906), the photo made by the author
The verification of rules according to which patients were selected for splenectomy was made thanks to the analyses of cases described in the medical literature. These analyses were made inter alia by Thornton (1886) , Wells (1888) , Abell (1933) , Lahey, and Norcross (1948) . Of 500 splenectomies carried out to 1930 at the Mayo Clinic, there were only two cases of wandering spleen . The analysis of 93 cases of wandering spleen with torsion of the pedicle made by Abell in 1933 showed that 88 cases occurred in women, mostly of an age ranging from 21 years to 40 years. The mortality rate among the operated patients amounted to 17.6 % .
Considering the high risk associated with splenectomy, clinical trials were carried out to decrease spleen size by pharmacological methods. In 1880 Goslin used hypodermic injection of ergotin into the enlarged spleen, and in 1883 Peiper injected fowler’s solution (a solution of potassium arsenite) directly into a leukemic spleen. However, the results of these treatments were not disclosed .
Following the example of a wandering kidney, which to the end of the nineteenth century any doctor without a special indication did not want to remove, in 1895 Ludwik Rydygier (1850–1920) operated to attach a wandering spleen to the peritoneum. This surgery, which he called splenopexy (following nephropexy), was based on fixation of the lower end of the spleen in a pocket made in the parietal peritoneum . In the same year Hall carried out splenopexy by making a lumbar incision into the abdomen and fixing the spleen in it by means of tamponade . One of the safest and easiest methods of splenopexy is Bardenheuer’s method, in which the spleen lies with its inferior pole in a retroperitoneal pouch; its pedicle is fixed to the peritoneal wound, and its body is suspended from the tenth rib.
Previous surgery course texts also taught splenorrhaphy, which is the suturing of the spleen for any purpose . At the beginning of the twentieth century, splenopexy became a standard surgical procedure in the treatment of wandering spleen, unless torsion of the pedicle of a wandering spleen was diagnosed .
The impact of experimental physiology on spleen surgery
Attempts to explain the spleen’s importance for life were made by conducting physiological experiments on animals. In 1735 Deisch proved that dogs could live even though they had their spleens removed. He removed the spleen by means of various surgical techniques, which in his opinion would become useful in the clinical setting . Special attention should be paid to pharmacological experiments done in the nineteenth century by Nivet (1838) and Pages (1846), who proved that the spleen decreased its size under the influence of alcohol and quinine. At the same time, similar experiments were done by Kűchenmeister, who used quinine and gentian violet to observe the spleen’s changes in size and the uptake of the dye. These more and more courageous experiments led to braver and braver conclusions. In 1857 John Harley announced that rats could live without a spleen and adrenal glands, and in 1866 Philipeaux presented the successful results of experiments related to transplanting a spleen taken from young animals and then replacing it in the abdominal cavity. The possibility of a spleen being transplanted was confirmed by Tizzoni in 1883 .
Such extraordinary spleen characteristics led Erwin Payr (1871–1946) to become interested in the spleen. In 1906 he presented to the German Surgeons’ Congress the results of experiments which referred to implanting fragments of the thyroid gland into a pouch made in the spleen into animals surgically deprived of thyroid; next, omentum was stitched over the splenic wound. Several days later the animals in the control group had their spleen with implemented fragments of thyroid gland removed, which resulted in tetanus and immediate death. Payr used these observations to treat a six-year-old girl diagnosed as a cretin and unsuccessfully treated her with thyroid tablets. He then took a sample of thyroid from the girl’s healthy mother and placed it in the girl’s spleen, which resulted in a considerable improvement in the child’s health. Similar experiments were carried out by William Halsted (1852–1922) .
These experiments were of clinical importance, yet determination of the function of the spleen remained unresolved (Fig. ). This impasse was broken in 1933 when Jűrgen Aschoff (1818–1896) and Edmund Landau (1877–1938) published their work about the reticuloendothelial system. The work indicated anatomical and physiological spleen similarity to Kupffer cells (some macrophages) of the liver, the medullary tissue of the bones, the lymphatic glands, and the cortex of the adrenal gland. All these tissues are composed of similar cells, and after spleen removal they can take over the spleen’s functions, which provides an explanation for the mechanism of how an organism adapts to the results of splenectomy .
Aschoff and Landau’s work was of significant value for surgeons who for many years had been observing the fact that a relatively small amount of postoperative bleeding followed removal of the spleen. The examination of blood composition before and after splenectomy indicated a significant postoperative increase in the number erythrocytes and blood platelets. Spleen surgery turned out to be an underlying topic at the International Surgical Congress held in Rome in 1926. Discussions started about accessory spleens, which appeared to number several hundred in one patient, some of them the size of a walnut. Patients who underwent reoperation after splenectomy sometimes had a diagnosis of enlarged splenules; what is more, it was proved that splenules took over the functions of a removed spleen .
Medical technologies and spleen surgery
The introduction of medical technologies represented a watershed in surgery for wandering spleen, which is confirmed by analyses of the PubMed database. Before the era of such medical technologies as isotopic imaging and angiography, the diagnosis of the torsion of a wandering spleen was difficult. Hence, in 1925–1976, publications related to this issue came out on average 0.34 times a year. In 1977–1997 publications referring to wandering spleen torsion appeared on average 3.45 times a year, and by 1998–2011, when laparoscopy became the gold standard in wandering spleen surgery, publications increased to 8.42 times per year.
Twentieth century medicine described wandering spleen in patients ranging from 3 months to 82 years . Accessory spleens occur in 10–15 % of the population. Generally, they are situated close to the splenic hilum, out of which 1–2 % are in the pancreatic tail, which is commonly mistaken on imaging studies for a neuroendocrine tumor  or neoplasm . They are also accidentally discovered during surgical procedures conducted on kidneys, the peritoneum, or reproductive organs , yet they are most commonly found in the vicinity of the stomach . Thus, surgery contributes to the progress of knowledge about spleen diseases.
At present wandering spleen is defined as an ectopic spleen that moved from its normal anatomical location because of congenital anomalies of the dorsal mesogastrium and the absence or malformation of normal splenic suspensory ligaments . Various imaging techniques can be used to diagnose a wandering spleen. For example, plain radiography, barium enema, scintigraphy, grey-scale sonography, computed tomography (CT), Doppler ultrasonography, and angiography [31, 32]. In cases where CT indicates the absence of the spleen in the left subphrenic space and finds a splenic-like mass in the abdomen or pelvis, diagnosis of a wandering spleen should be kept in mind .
The symptoms of abnormal spleen location with torsioned pedicle are splenomegaly and hemoperitoneum. Immediate splenectomy offers very good results in this a life-threatening condition, which occurs in no more than 0.2 % of cases . Since 1998, laparoscopic exploration of the abdominal cavity offers the ultimate diagnostic confirmation , enables splenectomy with short postoperative hospital stay followed by a quick recovery. Imaging techniques can be useful in making the right diagnosis, especially angio-spiral CT and color-flow ultrasonography .
Since 2000, splenopexy has been carried out laparoscopically if the wandering spleen is healthy and noninfarcted, is of normal size, and has no signs of hypersplenism. The literature describes the sandwich technique, in which two meshes are used to sandwich the spleen .
To 2007 the literature indicates almost 500 cases of wandering spleen  diagnosed in patients ranging from 3 months to 82 years of age . In recent years special attention has been paid to difficulties related to diagnosing wandering spleen in children , because clinical symptoms as well as laboratory test results are atypical. Thrombocytopenia is a rare complication of wandering spleen, usually accompanying torsion of an elongated splenic pedicle [38, 39]. The diagnosis of a wandering spleen can sometimes be very difficult because of the similarity of the clinical symptoms to those of recurrent pancreatitis . Moreover, medical technologies have elucidated the condition known as polysplenia, a complex congenital syndrome associating visceral heterotaxis and concomitant bilateral left-sidedness, when a spleen is divided into several splenules of the same size .
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Therapists in Moscow – latest reviews
An attentive specialist, explains everything clearly. It was clear that the doctor was interested in solving my problem. The doctor conducted a general examination, examination, prescribed tests, made a preliminary diagnosis and wrote me a referral to a neurologist.If necessary, I will come to him again.
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Show 10 reviews of 12,623 90,000 Spleen pain – causes of acute pain, indications for seeking medical attention
If a person develops pain in the left side of the hypochondrium, the first suspicions immediately fall on the pancreas or stomach.However, another, neighboring organ may also disturb.
The spleen is one of the most mysterious organs, the functions of which are not fully understood. It is the most important organ that helps the immune system: it is he who copes with filtering blood cells infected with viruses. The spleen is an organ-reservoir, a blood depot.
Pain in the spleen without the influence of external factors occurs only in one case – with a significant increase. Often, patients simply complain of discomfort, pulling sensations in the left abdomen.
Diseases that cause spleen pain:
- Infectious diseases (typhoid fever, hepatitis, anthrax, infectious mononucleosis, syphilis, tuberculosis)
Many infectious diseases affect the spleen, causing a painful symptom and starting a destructive process.
- Traumatic conditions of the spleen
They are divided into two types: open and closed. The first includes stab wounds, gunshot wounds to the chest region to the left or upper part of the abdominal cavity.
Closed injuries – bruises and fractures. In some cases, the spleen may rupture, which is accompanied by internal bleeding.
Organ damage, as a rule, is characterized by acute pain radiating to any part of the body, as well as a general deterioration in the condition.
- Organ infarction
It happens as a result of thromboembolism, as well as thrombosis. The state of a person with a spleen infarction is directly related to the magnitude of the pathology. If it is small, then an asymptomatic course is likely.With a large heart attack, pain occurs in the left hypochondrium with irradiation to the back, responsive to breathing.
- Abscess of the spleen
The pattern of pathology is fever, pain in the abdomen and chest, muscle tension.
- Parasitic diseases (most often echinococcosis)
- Benign and malignant neoplasms
- Enlargement of the spleen is often combined with enlargement of the liver (hepatolienal syndrome), which is observed in cirrhosis of the liver, portal hypertension, and blood diseases.
Any pain in the body is a signal for help.
Do not blindly ignore her and take painkillers indiscriminately. Pain and discomfort in the left hypochondrium may indicate several problems.
Only a doctor can determine the exact cause.
If you have pains of an unclear nature in the left hypochondrium, you can contact our clinic. For the correct diagnosis, specialists will conduct an examination and questioning, as well as prescribe the necessary studies.During the consultation, you can discuss all the symptoms in order to find the most effective and safe therapy.
Diagnostics and treatment
Diagnosis of spleen disease begins with a thorough examination by a physician. After palpation, collection of anamnesis, additional studies will be required – ultrasound, radiography, MRI or puncture. Laboratory diagnostics are also required.
The primary task is to correctly diagnose in order to prescribe an effective treatment.It should only take place under the supervision of an experienced technician.
Preventive measures to keep the organ healthy are very simple: proper nutrition and a healthy lifestyle. The spleen begins to work better with regular physical activity, as well as with special breathing exercises.
Pain in the spleen occurs when the organ has increased significantly in size. This may indicate various diseases that only a qualified doctor can diagnose.It is highly discouraged to make a diagnosis on your own and, moreover, to select a treatment.
After all, the spleen is one of the important organs responsible for supporting human immunity.
Timely contacting specialists will help you solve the problem at an early stage with minimal damage.
For early diagnosis of health problems, you can undergo a comprehensive diagnosis of the body in our center.
Best Diagnosis of Spleen Pain – MRI of the Spleen
You can sign up for a consultation right now: online or by phone number +7 495 478-10-03
The content of this article has been checked and confirmed for compliance with medical standards by a general practitioner of the highest qualification category, an allergist-immunologist Butskikh Yulia Vladimirovna.
Ultrasound of the spleen
Ultrasound of the spleen allows you to determine the main changes in the organ and see neoplasms in it in the form of tumors and cysts. If the patient has problems with the liver or with the hematopoietic system, doctors recommend immediately undergoing this study. You can visit such a diagnosis after the appointment of a doctor.
Indication for ultrasound of the spleen
The doctor will prescribe this procedure in the following cases:
- With abnormal development of the spleen.
- If diseases such as leukemia are present in the blood.
- To clarify the location of metastases in the spleen
- To control the correct treatment of the organ.
- If there is a suspicion of a malignant or benign tumor.
- For severe injuries to the spleen.
- If the patient has chronic liver disease. These include hepatitis and cystitis.
- For infectious diseases. For example, with syphilis, tuberculosis, infectious mononucleosis, typhoid fever and sepsis.
How to prepare for the procedure?
It is important to properly prepare for an ultrasound of the spleen so that the result of the study is as accurate as possible. We will describe the basic rules to be followed:
- If the patient often has gas in the body, then you need to take activated charcoal the day before the ultrasound.
- Two days before the procedure, you must not eat raw vegetables, milk, bread and legumes. Such foods are conducive to fermentation.Because of this, a swollen intestine will obstruct the spleen and impair the examination process.
- An ultrasound scan should be performed on an empty stomach in the morning.
- You can eat for the last time before the procedure in 7 hours.
- If a person has diabetes, he can have a cup of tea and light crackers in the morning.
Ultrasound of the spleen
Let’s take a step-by-step process of the procedure:
- The doctor asks the patient to be placed comfortably on the couch with his stomach up.
- The specialist applies a non-allergenic diagnostic gel to the abdomen. This tool is necessary so that the sensor glides better over the skin and the ultrasonic waves penetrate as deeply as possible into the tissue. This allows you to get an accurate diagnosis and detect any neoplasms.
- Next, the specialist performs the research and sees the big picture.
- An ultrasound of the spleen takes about 15 minutes. The test results are ready immediately after the procedure.
It is important to note that sometimes the diagnostic process is difficult.This occurs due to the anatomical features of the patient’s body. In this case, the doctor asks you to change your posture, lie on one side or bend over a little. In some cases, the specialist will ask you to take a deep breath. If the ultrasound does not give a clear picture, then it is performed through the intercostal space.
How to detect diseases using ultrasound?
The study will help determine leukemic infiltration in the spleen. Then the ultrasound will show:
- The spleen is too enlarged.
- The contours of the organ are convex.
- Lymph nodes are enlarged.
- The echo structure has increased significantly.
- The density of the parenchyma has increased.
The doctor can also, after an ultrasound scan
, determine an abscess in the body if:
- Acid is present in the spleen. On ultrasound, it is shown in the form of a small oval with an uneven outline.
- Echostructure mixed or hypoechoic.
Hematoma can be determined by the following indicators:
- The spleen has irregular contours.
- Echostructure anechoic or mixed.
In case of a heart attack, the doctor sees through ultrasound the compacted tissue of the spleen. Sometimes this same tissue can be severely depleted. It is also possible to determine the gap through such research. The ultrasound will show uneven contours of the spleen. The doctor will see fluid in the abdomen. It can also be present in the subphrenic space. This will help the specialist make the correct diagnosis. Ultrasound makes it possible to identify the disease and start the correct treatment on time.
Now you know what an ultrasound of the spleen is and when a doctor can prescribe this study. We have learned how to properly prepare for the procedure so that the results are as accurate as possible. You know in what sequence the ultrasound scan takes place, and what diseases it can show. You can undergo an ultrasound of the spleen in the Mogilev hospital №1. You will receive an accurate research result and will be able to start the correct treatment of the disease.
Surgical treatment of cysts and tumors of the spleen in Kiev
Please pay attention! Hospitalization and surgical intervention at the Oxford Medical clinic require a mandatory PCR test for coronavirus.
A cyst is a benign, hollow neoplasm filled with fluid, which is separated by a capsule from the surrounding tissues. In many cases, neoplasms of the spleen are a consequence of diseases of other organs and systems: blood diseases, immune disorders, tumors, systemic diseases or injuries of the spleen.
Signs of spleen neoplasms
The manifestations of the disease vary depending on the location of the formation, its type and size. Small cysts up to 2 cm may not show themselves in any way.Usually, the first symptoms are noted when the neoplasm becomes inflamed or compresses the adjacent blood vessels.
Possible symptoms include:
- persistent or paroxysmal pain in the abdomen or left side;
- unexplained weight loss;
- Constant heaviness or fullness in the abdomen;
- Unreasonable fatigue.
As the cyst grows in size, the pain becomes more intense, may be complemented by nausea and vomiting for no apparent reason.When the inflammatory process joins, chills and fever occur.
Complications of spleen tumors
Rupture of a spleen cyst with leakage of cyst contents into the abdominal cavity causes acute attacks of pain, severe intoxication and peritonitis.
In case of infection, suppuration of the cyst and general intoxication of the body may develop. Against the background of infectious processes or other diseases of the spleen, neoplasms can degenerate into malignant tumors.
Diagnostics and treatment of spleen neoplasms
In most cases, spleen cysts are found on ultrasound or computed tomography, during routine examinations or during the diagnosis of diseases of the digestive system. Spleen neoplasms can appear against the background of helminth invasions, so doctors often prescribe bacteriological studies to make sure they are absent.
According to statistics, from benign tumors of the spleen, hemangiomas, lymphangiomas, lymphomas, fibromas are most often diagnosed.
Malignant neoplasms of the spleen can be divided into primary and secondary (metastatic). Primary ones are sarcomas, malignant lymphomas and other formations, the primary focus of which is located in the spleen. Secondary tumors include metastases in the spleen caused by oncological diseases of other organs. To exclude oncology, computed tomography of the abdominal organs with contrast is performed.
If other methods of treatment do not give results, splenectomy is prescribed – partial resection of the spleen tissues or removal of the organ completely.
Surgical treatment of cysts or tumors of the spleen is carried out by the laparoscopic method – it is minimally invasive, practically leaves no traces, allows simultaneous diagnostic or therapeutic manipulations on other abdominal organs, and rehabilitation after surgery is quick and easy.
To make an appointment with a surgeon at the Oxford Medical clinic, call or fill out the form on the website.
Instructions after hospital discharge: open splenectomy
Do not climb stairs more than one or two times a day.Climb slowly, stopping to rest every few steps.
Do not lift over 4.5 kg or vacuum yourself for 4 to 6 weeks after surgery.
Do not drive until the first medical check-up after surgery.
If you are driving long distances, stop often to stretch and stretch your legs.
Ask your PCP when you can go to work.
Gradually increase the intensity of the exercise. Take short walks on level ground.
Do not tire yourself to the point of exhaustion. If you are tired, take a break.
Shower as needed. Ask a friend or family member to be with you at this point in case you need help.
Wash the wound with soap and water, pat dry after washing.
Check the incision daily for redness, drainage, swelling or dehiscence.
Take this medicine exactly as directed. Don’t miss your medication.
Do not take over-the-counter drugs without your doctor’s approval.
Measure temperature daily for one week after surgery.
Return to normal power mode if possible. Eat a healthy, balanced diet.
Ask your healthcare provider about the vaccinations you need to get.You are more susceptible to infections after surgery.
Medical supervision is necessary even for mild illnesses such as a runny nose or colds. Your doctor may find it necessary to prescribe antibiotics and monitor your condition.
Remember, your risk of infection is high because you do not have a spleen.
After surgery, take antibiotics as directed by your healthcare professional. You may need to take antibiotics to protect yourself from infection.
Be sure to tell all medical personnel you work with (dentist, family doctor, nurse practitioner, etc.) that your spleen has been removed.
Wear a special signal bracelet that says you don’t have a spleen.
Spleen cyst in a child – removal or treatment?
Such a disease as a spleen cyst has been studied by modern medicine at a rather serious level.However, no specific factors that provoke the onset of neoplasm have not been identified at present.
Mikhail Yuryevich Kozlov, head of the surgical department of the Morozov Children’s Hospital, a coloproctologist, a pediatric surgeon of the highest qualification category, a candidate of medical sciences, an owner the status of “Moscow doctor”.
– Why do spleen cysts occur in newborns?
Spleen cysts are divided into two large groups – true and false.This classification has been used by doctors since 1924. True cysts are congenital, false cysts are acquired. The first group accounts for 25% of all diseases of the spleen, the rest is accounted for by false or acquired ailments, including neoplasms.
Congenital or true spleen cysts appear, like any malformation, during the formation of an organ in a child in the womb. To be precise, at the stage of the formation of the vessels that feed the spleen. This is probably due to genetic reasons.It also happens that tissues atypical for an organ can migrate into its structure and cause the formation of cysts in the future.
Acquired or false cysts of the spleen are, as a rule, post-traumatic neoplasms caused by previous diseases.
Parasitic cysts are also distinguished into a separate group, the cause of which may be alveococci, echinococci and other pathogens.
To date, the disease has been studied at a fairly serious modern level.However, it is difficult to determine exactly what caused the appearance of a spleen cyst: external factors or intraorgan changes.
– What are the signs of a spleen cyst in a child? What signals should you pay attention to?
Spleen cysts are slowly growing neoplasms, therefore, rarely when the disease is acute. As a rule, a small cyst is an “accidental find”.
If the cyst is large, it causes dysfunction of the organ, displacement of the spleen itself or adjacent organs.In this case, the patient may complain of burning sensation, heaviness and other discomfort in the left hypochondrium. But it happens that large cysts do not manifest themselves in any way.
– When does a child need surgery?
When the size of the cyst is less than 3-4 centimeters, the neoplasm does not have any clinical manifestations and does not cause complaints in the child, then observation is sufficient. Of course, provided that the doctors are confident that it is not a malignant tumor and there is no growth dynamics.A cyst larger than 4 centimeters is an indication for surgical treatment.
– Tell us about the most reliable methods for diagnosing a disease?
The most common and accessible diagnostic method is an ultrasound scan of the abdominal cavity, thanks to which it is possible to determine whether there is any neoplasm in the spleen or not. After the presence of a cyst was confirmed, it is important for me as a surgeon to also perform computed tomography (CT) with contrast and magnetic resonance imaging (MRI).On CT, we can clearly determine the localization of the neoplasm, its size, relation to the leg of the spleen, where the vessels are located. All this is important information for the operation. According to MRI, it will be clear whether the parasitic cyst is or not – the secondary and inner shell of the pathogen, and maybe the pathogen itself, will be clearly visible. All these studies are available at the Morozov Hospital.
– What types of surgery are used in the hospital?
Another 15 – 20 years ago, as a rule, splenectomy was performed – removal of the spleen.With the advent of endoscopic CT and MRI studies, it became possible at the diagnostic stage to differentiate diagnoses of benign and malignant neoplasms. As a result, surgeons began to perform more organ-preserving surgeries. At first, these were laparotomy operations with large incisions in the abdomen, when part of the spleen was removed or a cyst was resected. In 1995, the first laparoscopic resection of the spleen cyst was performed in Moscow. Since then, this operation has become widespread in our country.
To date, our hospital carries out:
– Laparoscopic partial resection of the spleen, when a part of the spleen with a neoplasm is removed.
– Fenestration of the cyst, when the “lid” of the neoplasm is removed and its contents are evacuated.
– Argon plasma coagulation – an advanced technology, when the inner lining of the cyst is burned out, which prevents recurrence in the future.
The most common operations today are laparoscopic partial resection of the spleen and fenestration of the cyst with decortication and burning of the inner lining.The operations are performed through three small punctures under a microscope. Even with large or giant cysts, operations last from 1.5 to 2 hours. In this case, the anterior abdominal wall is minimally injured. The probability of relapse after such an operation is no more than 5-10%. The child recovers very quickly; resuscitation is almost never required. With a successful operation and a good postoperative period, the patient is discharged home in 3 – 5 days healthy.
As an alternative to laparoscopic operations, there is a newer technique called “ultrasound-guided percutaneous puncturing of the cyst”. However, the technology has significant limitations: it can be used in cases where there is one hundred percent certainty that the cyst is benign and there are no large vessels nearby. In addition, there are many reports that after such manipulations, up to 50% of relapses are observed. Therefore, this technique is rarely practiced.
On average, we operate on 20 – 25 children with true spleen cysts per year. By the way, malignant neoplasms are very rare, during my practice it was a maximum of 3 times.
– These high-tech operations probably require special equipment?
Yes, such operations require unique and expensive equipment. Not all hospitals have such modern equipment. The Morozov hospital has all the necessary equipment in full.For example, an argon plasma coagulator. We have two of them.
Argon plasma coagulator allows you to burn out the inner lining of the cyst and control hemostasis (the body’s system, the function of which is to keep blood in a liquid state and stop bleeding). This is very important in operations on the spleen, since it belongs to the blood-forming organs and is very well supplied with blood. When a partial resection of the spleen is performed, it is important to achieve 100% hemostasis so that there are no complications, and there never were complications.
– Are all of the listed operations available under the compulsory medical insurance policy?
Laparoscopic partial resection of the spleen, cyst fenestration and argon plasma coagulation are carried out in our hospital one hundred percent free of charge under the compulsory medical insurance policy.
– What is the largest cyst size in your practice?
We operated on the largest cyst in my practice three years ago on a teenage girl. The volume of the neoplasm was 12 liters.Due to the fact that the cyst was huge, she displaced the spleen into the abdominal cavity. During the operation, 12 liters of fluid were evacuated, the organ was preserved and returned to the anatomically correct place. Further, the patient was monitored: the spleen successfully engrafted and functioned normally.
A year ago, there was also a boy with a giant cyst with a volume of 2.5 liters. This “find” was accidental: during the medical examination on the ECG, the laboratory assistant noticed that the child had an asymmetric chest, and the ultrasound showed a large neoplasm up to 25 centimeters in diameter.At the same time, the child did not complain about anything. Meanwhile, giant cysts are dangerous. If the boy unsuccessfully fell on his left side or someone hit him, it would result in a ruptured spleen.
Source: Moscow – the capital of health
90,000 ultrasound of the abdominal cavity (gallbladder, liver, pancreas, spleen) |
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