Splenomegaly – Dr Michael Crawford Laparoscopic & Bariatric Surgeon

Spleen Disorders

Surgical Conditions of the Spleen

Spleen enlargement; Enlarged spleen

Splenomegaly is an enlargement of the spleen beyond its normal size. Hepatosplenomegaly is enlargement of both the liver and the spleen.

The spleen is an organ involved in the production and maintenance of red blood cells, the production of certain circulating white blood cells, and is a part of the lymph system and the immune system. It also has a phagocytic role and acts as a filter for circulating microorganisms, old and deformed red cells, and other antigens.

Because of its wide variety of functions, the spleen may be affected by many conditions involving the blood or lymph system, and by infection, malignancies, liver disease and parasites.

The Spleen is sometimes removed (SPLENECTOMY) for the following conditions:

Idiopathic Thrombocytopenic Purpura (ITP)

This is a hematological condition leading to a low platelet count
Surgery is recommended when simple medical measures are unsuccessful

Other Hematological conditions

Some other blood diseases benefit from splenectomy either because the spleen is too big (Splenomegally) or because splenectomy benefits the treatment

Cysts or Tumours

Some conditions (like melanoma or hydatid disease) can affect the spleen, and removal is often recommended

Trauma

In the event of ‘rupture’ the spleen might need to be removed, but more and more, we are able to control bleeding without removal in many cases

Removal as part of other surgery

The most common here is removal of the spleen with the ‘Tail of the Pancreas’ when there is a tumour there

Liver Cirrhosis

When the spleen is enlarged due to a build-up of vein blood pressure (portal hypertension), it is rare to recommend splenectomy.

Splenectomy

The spleen can usually be removed laparoscopically through 4 small incisions (it is mushed up in a bag before it is sucked up and pulled out)
Patients stay around 3 days after surgery

Consequences of Splenectomy

Given that the spleen is involved with the ‘recycling’ of blood cells, it is not surprising that splenectomy leads to an increase in some of the circulating blood cells, particularly platelet counts. We are able to live normally without a spleen because its functions are largely compensated for by liver and bone marrow activity. One particular issue though is a lifetime increased risk of certain infections, Dr Crawford will arrange for immunisations for these and recommend a daily low dose antibiotic.