Splenectomy for Trauma / Tumours / Cancers
The spleen is a small organ located in the left upper abdomen, adjacent to the stomach and below the left rib cage. Its main functions are to store and filter blood. It also plays a role in the immune function of the body by producing certain types of white blood cells and antibodies that fight against certain micro-organisms.
An increase in the size of the spleen is called splenomegaly. In these cases, the spleen may function more than required. Conversely, the spleen may function less in certain conditions, which can be equally detrimental.
The spleen can be affected and enlarge in size due to different blood diseases (such as haemolytic anaemias, leukaemia, or blood cancers), lymphomas, protein disorders (like sarcoidosis, amyloidosis, cystic fibrosis), infections (like malaria, syphilis), or cancers that have spread from other sites.
Considering its location right under the left rib cage, the spleen is prone to trauma. Traumatic spleen injuries can be life-threatening. Minor injuries to the spleen can often be salvaged.
An abnormally enlarged spleen, a less functioning spleen, or a badly injured spleen that is actively bleeding and cannot be salvaged requires removal, known as splenectomy.
Splenectomy can be an elective planned procedure or an emergency procedure in the setting of trauma and bleeding. Vaccinations are crucial for splenectomy. In elective cases, vaccines are administered prior to surgery, while in emergency situations, vaccines are given after surgery.
Symptoms:
- Abdominal pain, which is more severe in the left upper regions
- Difficulty in breathing or shortness of breath
- Tiredness
- Shock
- Heaviness in the abdomen
- Abdominal bloating or fullness
- Nausea or vomiting
Diagnosis:
- Complete blood counts with peripheral smear
- Iron studies
- Tests for malaria
- Bone marrow studies
- Ultrasound abdomen and pelvis
- CT abdomen and pelvis with intravenous contrast
Treatment:
- Open splenectomy
- Laparoscopic splenectomy
Removing a portion of the spleen is not an option; whenever indicated, the entire spleen needs to be removed. This can be done by the standard open technique or laparoscopic route. Laparoscopic splenectomy is the treatment of choice.
Using multiple small keyholes, the spleen is separated from its surrounding organs, namely the stomach, pancreas, large intestine, and its attachments to the diaphragm are released. Blood vessels going to and coming from the spleen are divided using various gadgets, and the spleen is removed in its entirety.
