The spleen is an upper abdominal organ that is part of the body's defense system and is therefore involved in shaping the defense cells. In addition, it eliminates the obsolete and no longer functional blood cells. The spleen is located in the left upper abdomen. Adjacent are the diaphragm, the pancreas, the stomach and the large intestine. The average organ size in adult people is about 11x7x4 centimeters.
Diseases (benign, malignant)
Acute and chronic conditions can make spleen surgery necessary. An emergency situation is the splenic injury (splenic rupture), which often occurs after a fall (especially on the left flank) or after a car accident and can possibly be life-threatening due to bleeding. Such a splenic rupture can be one-time, i.e. that it tears and bleeds directly due to the violence. However, after an initial phase of up to two weeks with little discomfort, which can sometimes last up to two weeks, it can also be noticed by a capsular tear with bleeding into the abdominal cavity (so-called two-stage splenic rupture).
In addition, a planned (elective) operation may be indicated if the spleen is enlarged (splenomegaly) in different ways, splenic cysts and certain diseases of the blood and bone marrow (e.g. ball cell anemia). Tumors of the spleen or lymphatic system may also need to be removed during a scheduled operation. Excessive activity of the spleen, usually with enlargement of the organ, can also be a condition worthy of surgery. Here, too much degradation of intact blood cells takes place (e.g. in Werlhof's disease).
Splenic surgery for splenic injury or splenic rupture
If you suspect a severe spleen injury (splenic rupture), surgery must usually be carried out immediately, otherwise extensive blood loss due to bleeding will enter the abdominal cavity. In the case of only minor injuries, it may be possible to wait under close monitoring (ultrasound, blood values). Some of the operations can be performed minimally invasively using a laparoscopy. Depending on the severity of the injury, hemostasis alone or partial removal of the spleen may be sufficient. The blood vessels are preserved and the spleen is sutured in the open area, closed with special tissue glue or scabbed by heat (coagulation). Sometimes a mesh is placed around the spleen to stop the bleeding using compression. In the case of extensive injuries, an abdominal incision is usually made; if the bleeding cannot be stopped, the spleen may have to be removed (splenectomy).
Drainage systems for the absorption of fluid and blood into the abdominal cavity are usually inserted at the end of the operation and can be removed again after a few days.
Planned (elective) spleen surgery
Depending on the disease, partial or complete removal of the spleen is necessary. Before the operation, the necessary vaccinations to avoid dangerous infections should be carried out by reducing the defense against infections resulting from the removal of the spleen.
Risks / complications
In addition to general surgical risks, postoperative bleeding can occur during operations, especially partial removal of the spleen, which may also require another operation. Surrounding organs can be damaged by the procedure (stomach, colon, pancreas), in extreme cases, inflammation of the peritoneum can occur, which can be life-threatening. Infections up to sepsis (inflammation spread through the blood throughout the body) can occur after removal of the spleen.
The number of platelets (platelets) generally increases significantly after removal of the spleen, increasing the risk of thrombosis (blood clots), which is why acetylsalicylic acid or similar drugs should be given prophylactically postoperatively.
To reduce the risk of infection, antibiotics can be taken prophylactically or vaccinations given a few weeks beforehand. If there are any abnormalities that indicate complications, especially fever, the doctor should be contacted immediately.