Splenectomies

What Is the Spleen?

The spleen is a fist-sized organ in the upper left part of the belly under the ribcage. It helps protect the body by clearing worn-out red blood cells and other foreign bodies (such as germs) from the bloodstream.

What Is a Splenectomy?

A splenectomy (splih-NEK-tuh-mee) is surgery to remove an injured spleen. In the past, doctors often did this surgery if the spleen was torn ("lacerated") or bruised by a blow or blunt trauma to the abdomen. Doctors grade spleen lacerations on a scale from 1–5, where 1 is the least severe and 5 is the most severe.

But most spleen bruises and lacerations heal with lots of rest and limiting physical activity. Doctors will do all they can to help an injured spleen heal without removing it because it's so important to fighting infection.

When Are Splenectomies Done?

To treat some spleen injuries and problems, doctors may do a splenectomy. For example:

• More serious abdominal injuries (for instance, from a car accident) can cause a ruptured spleen. If the spleen breaks open (ruptures), it can lead to life-threatening internal bleeding.
• Sickle cell disease can injure the spleen. A splenic sequestration crisis is when the spleen traps the sickle-shaped red blood cells instead of clearing them out. So the organ can swell and get very large. This can lead to a serious, quick drop in the number of red blood cells in the bloodstream. Signs include paleness, weakness or extreme tiredness, and belly pain.
• Hereditary spherocytosis and alpha thalassemia are blood disorders in which the spleen has to work harder than normal to break down and filter blood cells, which can lead to low levels of blood cells.
• Immune thrombocytopenia (or immune thrombocytopenic purpura) is when the immune system attacks platelets (blood cells that stop bleeding by forming blood clots). The spleen removes platelets from the blood, so a splenectomy can help the body keep more of these important cells. This is done only when serious symptoms don't improve with other treatments.
• Some cancers, like certain types of leukemia (blood cancers) or lymphomas (cancers that affect the infection-fighting lymphatic tissue).

What Happens During a Splenectomy?

A child will get general anesthesia before a splenectomy to sleep through the procedure and not feel pain. Often surgeons can remove the spleen by doing minimally invasive surgery. This usually uses three or four tiny cuts (incisions) in the skin rather than a large cut as done in traditional surgery.

In this surgery, the surgeon:

• uses a laparoscope (a thin tube with a light and tiny video camera on the end) to see inside the abdomen and find the spleen
• separates the spleen from the surrounding tissues and blood vessels
• removes the spleen through one of the cuts in the skin
• closes the cuts with stitches

An open splenectomy is similar to laparoscopic surgery but requires a larger cut in the skin. Doctors might use this option if a spleen is very large or swollen.

How Can Parents Help?

If your child had a splenectomy:

• Help your child follow the surgeon's instructions about managing pain. Ask what medicine you can give your child for pain if needed.
• Give prescribed antibiotics as directed.
• No sports, gym class, rough play, climbing, or physical activity until the surgeon says it's OK.
• Follow instructions for when your child can shower or bathe.
• Follow up with your child's surgeon as instructed.
• Get your child a medical alert bracelet that states they had a splenectomy.

What Else Should I Know?

Kids whose spleen was removed are at a higher risk for infections. Some will take antibiotics regularly to help prevent infections. Doctors also might recommend that they get more vaccines than other kids their age (such as vaccines against more types of pneumococcal infections).

Tell all health care providers your child sees about the splenectomy, as well as coaches and other caregivers.

When Should I Call the Doctor?

Call the doctor if your child:

• still has pain after taking pain medicine
• has swelling or bulging of the abdomen
• develops left shoulder pain
• has a fever above 101°F (38.3°C)
• has increasing redness or drainage from the incision sites
• develops other signs of infection such as chills or vomiting
• has trouble pooping

Go to the ER right away if your child:

• has severe belly pain
• looks pale and is very sleepy
• is dizzy or faints
• vomits blood or has blood in the urine (pee) or feces (poop)
• has signs of dehydration, such as a dry or sticky mouth, sunken eyes, less pee or darker than usual pee, crying with little or no tears