Common indications for splenectomy surgery

Splenectomy, the surgical removal of the spleen, is a procedure that can be necessary for various medical conditions. The spleen plays an essential role in filtering blood and fighting infections, but there are situations where removing it can be beneficial or even life-saving. In this article, we will explore the common indications for splenectomy surgery, delving into various medical conditions and scenarios where this procedure is warranted.

Understanding the Spleen

The spleen is an organ located in the upper left part of the abdomen, near the stomach. It is part of the lymphatic system and performs several vital functions, including:

• Filtering old and damaged blood cells
• Storing white blood cells and platelets
• Fighting certain kinds of bacteria that cause pneumonia and meningitis

While the spleen is important, it is not essential for survival. If it is removed, other organs, like the liver, can compensate for many of its functions.

Indications for Splenectomy

There are several indications for splenectomy, ranging from hematologic disorders to traumatic injuries. Below, we discuss the most common reasons why splenectomy may be necessary.

Hematologic Disorders

Hematologic disorders are conditions that affect the blood. Some of these disorders can lead to problems with the spleen, making splenectomy a beneficial treatment option.

Hereditary Spherocytosis

Hereditary spherocytosis is a genetic condition that causes red blood cells to be shaped like spheres instead of discs. These misshapen cells are often destroyed in the spleen, leading to anemia. Removing the spleen can help reduce the destruction of these cells and alleviate anemia.

Immune Thrombocytopenic Purpura (ITP)

ITP is an autoimmune disorder where the body's immune system attacks and destroys platelets, which are essential for blood clotting. In cases where medication does not improve platelet counts, splenectomy can help by removing the primary site of platelet destruction.

Thalassemia

Thalassemia is a genetic blood disorder that results in the production of abnormal hemoglobin. This can lead to the destruction of red blood cells in the spleen. In severe cases, splenectomy may reduce red blood cell destruction and improve symptoms.

Splenic Rupture

A ruptured spleen is a medical emergency that often results from trauma, such as a car accident or a severe blow to the abdomen. When the spleen ruptures, it can cause internal bleeding and severe pain. Immediate splenectomy is usually required to stop the bleeding and prevent life-threatening complications.

Splenomegaly

Splenomegaly refers to an enlarged spleen. Various conditions can cause the spleen to become enlarged, which can lead to symptoms such as pain, fullness, and anemia.

Causes of Splenomegaly

• Infections: Conditions such as mononucleosis, malaria, and bacterial infections can cause the spleen to enlarge.
• Liver diseases: Cirrhosis and other liver conditions can lead to an enlarged spleen.
• Blood cancers: Leukemia and lymphoma can cause splenomegaly.

In cases where splenomegaly leads to significant symptoms or complications, splenectomy may be recommended.

Trauma

Splenic injury due to trauma is another common indication for splenectomy. Trauma can result from various incidents, such as motor vehicle accidents, sports injuries, or falls. Depending on the severity of the injury, splenectomy may be necessary to prevent complications like severe internal bleeding.

Other Indications

There are other less common indications for splenectomy, including:

• Splenic abscesses: Infections within the spleen that do not respond to antibiotics may require splenectomy.
• Cysts and tumours: Benign or malignant growths in the spleen may necessitate their removal.
• Hypersplenism: A condition in which the spleen becomes overactive and starts destroying blood cells at an accelerated rate.

Contraindications for Splenectomy

While splenectomy can be beneficial in many situations, it is not suitable for everyone. Certain conditions may make the surgery risky or unnecessary.

Absolute Contraindications

• Severe infections: Active, severe infections elsewhere in the body can increase the risk of complications from surgery.
• Poor overall health: Patients with significant comorbidities or poor overall health may not tolerate surgery well.

Relative Contraindications

• Mild splenomegaly without symptoms: If the spleen is only slightly enlarged and not causing symptoms, splenectomy might not be necessary.
• Treatable underlying conditions: If the condition causing splenic issues can be treated effectively without surgery, splenectomy may not be required.

Preparing for Splenectomy

Before undergoing a splenectomy, patients typically undergo a thorough evaluation to ensure they are suitable candidates for the procedure. This evaluation often includes blood tests, imaging studies, and consultations with specialists.

Vaccinations

Patients scheduled for splenectomy are usually advised to receive vaccinations against certain bacteria, such as pneumococcus, Haemophilus influenzae type b, and meningococcus. These vaccinations help reduce the risk of infections after the spleen is removed, as the spleen plays a crucial role in fighting these bacteria.

Preoperative Assessment

A preoperative assessment will include a detailed medical history, physical examination, and discussions about the risks and benefits of the surgery. Patients may also be advised to stop taking certain medications, such as blood thinners, before the procedure.

Postoperative Care and Recovery

Recovery from a splenectomy involves both short-term and long-term care.

Immediate Postoperative Care

After the surgery, patients are usually monitored in the hospital for a few days. Pain management, wound care, and monitoring for complications such as infection or bleeding are essential aspects of immediate postoperative care.

Long-Term Considerations

Without a spleen, patients are at a higher risk of infections. Long-term care involves:

• Regular vaccinations: Patients need to stay up-to-date with vaccinations to prevent infections.
• Prophylactic antibiotics: Some patients may be prescribed antibiotics to take regularly, especially if they have other risk factors for infections.
• Awareness of symptoms: Patients should be educated about the signs of infection and advised to seek medical attention promptly if they experience symptoms such as fever, chills, or unexplained pain.

Conclusion

Splenectomy is a significant surgical procedure with various indications, primarily involving hematologic disorders, splenic rupture, and trauma. Understanding the reasons for splenectomy, as well as the contraindications and necessary preparations, is crucial for both patients and healthcare providers. With proper care and precautions, patients who undergo splenectomy can lead healthy and fulfilling lives.

Frequently Asked Questions