Spleen problems and spleen removal

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

The spleen is a fist-sized organ found in the upper left side of your abdomen, next to your stomach and behind your left ribs. 

It is 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 a few important functions:

• It fights any invading germs in the blood (the spleen contains infection-fighting white blood cells).
• It controls the level of blood cells. The spleen controls the level of white blood cells, red blood cells and platelets (small cells that form blood clots)
• It screens the blood and removes any old or damaged red blood cells.

If the spleen doesn't 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, from a reduced number of platelets

Spleen problems

Spleen pain

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 rupture (burst) after a forceful blow to the abdomen, car accident, sporting accident or fracture to the 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, the pain can be felt 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've ruptured or damaged your spleen.

Enlarged spleen

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

An enlarged spleen doesn't 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/or 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 would 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. Antibiotics may be prescribed 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 is enlarged.

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

Splenectomy (having the spleen removed)

An operation to remove the spleen, known as a splenectomy, may be needed if the spleen is damaged, diseased or enlarged.

It may sometimes be more appropriate to have just part of your spleen removed – a partial splenectomy.

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

Laparoscopy

Most splenectomies are carried out using laparoscopy (keyhole surgery).

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

Laparoscopic splenectomy allows a surgeon to access the inside of your abdomen without having to make large incisions (cuts) in your skin. However, you will still need a general anaesthetic.

The procedure involves:

• Making several incisions in your abdomen (tummy area).
• Guiding a laparoscope into your body through one of the incisions, so doctors can see what they're doing. 
• Passing thin instruments into your abdomen through the other incisions, to remove your spleen. Gas will be pumped into your abdomen to make this easier.

The incisions will then be stitched up or sometimes glued together. You may be able to go home the same day, or 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

Open surgery, where one large incision is made, may be needed if the spleen is too large or too damaged to be removed via keyhole surgery. Often, in emergencies, this will be the preferred method to rapidly control bleeding.

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

Afterwards

It's normal to feel sore and be bruised after a splenectomy, but you'll be given pain relief medication.

You should be able to eat and drink as normal soon after the operation.

Like any operation, a splenectomy carries a small risk of complications, including bleeding and infection.

Your doctor will run through these risks with you.

You should be given breathing and leg movement 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 will still be able to cope with most infections. However, there is a small risk that a serious infection may develop quickly. This risk will be present for the rest of your life.

Risk of infection

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 medical condition such as sickle cell anaemia, coeliac disease or a condition that affects your immune system, such as HIV.

This risk can be minimised by following simple precautions to prevent infection.

Vaccinations

Make sure you have had all your routine childhood vaccinations. You should also be vaccinated against:

• pneumococcal infections such as pneumonia, with regular boosters at least every five years
• flu (get the seasonal flu jab every autumn) 
• Haemophilus influenzae type b (Hib) 
• meningitis C (MenC) 

Antibiotics

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 two years after your spleen is removed 
• if your immune system doesn't work properly

Be alert for signs of infection

Watch out for signs of infection, such as:

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

Your GP can prescribe a course of antibiotics for you to use if you get an infection. You should start taking them at the first sign of an infection, so see your GP as soon as possible.

If your infection becomes serious, you will be admitted to hospital.

Animal and tick bites

Bites from animals and ticks (small blood-sucking parasites) can cause infections.

If you get bitten by an animal, particularly a dog, start your course of antibiotics and seek medical advice urgently.

If you go trekking or camping regularly, you may be at risk of babesiosis, which is a rare 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.

Telling medical staff about your condition

Healthcare professionals will mark your health records to show that you don't have a working spleen. However, 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. For example:

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

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

Travel abroad

If you're travelling abroad:

• you may be advised to take a course of antibiotics with you
• find out if you need an extra meningitis vaccination (types ACWY) 
• 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 can't, speak to your GP or local pharmacist about anti-malaria medicine before you travel. You should also use mosquito nets and insect repellent. 

Scars

The scars from your operation will gradually fade. Learn more about scars.