Spleen

The spleen is located in the upper left part of the abdomen, behind the stomach and beneath the ribs. It contributes to the regulation of blood cells and protection against certain infections. Spleen conditions range from injury and cysts to infections, vascular problems, tumours and blood disorders. Assessment combines clinical examination, blood tests and imaging, and treatment ranges from observation to minimally invasive or open surgery.

Splenic trauma and rupture

What it is: An injury to the spleen, most often after a road traffic accident, fall, sporting injury or a strong impact to the upper left abdomen or left ribs. It ranges from a minor injury to a deep rupture with bleeding into the abdomen.

Symptoms: Pain in the upper left abdomen, tenderness beneath the left ribs and pain referred to the left shoulder. Dizziness, weakness, a rapid heart rate or low blood pressure may indicate significant internal bleeding.

Treatment: Many stable patients are managed without an operation, with close monitoring. Active bleeding may be treated with splenic artery embolization, and emergency surgery, often splenectomy, is required for instability or uncontrolled bleeding.

Splenic cysts and parasitic conditions

What it is: Fluid-filled cavities in the spleen: congenital or true cysts, post-traumatic pseudocysts, or parasitic cysts due to echinococcosis. Many are found incidentally on ultrasound or CT.

Symptoms: Small cysts usually cause no symptoms; larger cysts can cause pain or heaviness in the left upper abdomen, early satiety or nausea.

Treatment: Simple, small, asymptomatic cysts are usually observed. Large, symptomatic, enlarging or complicated cysts may need cyst excision, partial or total splenectomy, preserving splenic tissue when technically safe.

Infections and inflammatory conditions of the spleen

What it is: Splenic abscess, candidiasis, tuberculosis and splenic involvement by sarcoidosis. An abscess usually develops when microorganisms reach the spleen through the bloodstream.

Symptoms: Fever, chills, malaise and pain in the upper left abdomen, although these are not always present.

Treatment: Targeted antimicrobial therapy, often with image-guided percutaneous drainage. Splenectomy is considered when safe drainage is not possible, the infection is not controlled or there is rupture.

Vascular conditions of the spleen

What it is: Splenic infarction, splenic vein thrombosis, splenic artery aneurysm or pseudoaneurysm and rare arteriovenous malformations.

Symptoms: Infarction may cause pain in the left upper abdomen, fever or tenderness. Splenic vein thrombosis may cause no symptoms or present with complications of portal hypertension, and aneurysms are often found incidentally.

Treatment: Infarction is usually managed conservatively while the cause is investigated. An aneurysm or pseudoaneurysm may require endovascular embolization or surgical repair.

Focal lesions and tumors of the spleen

What it is: Hemangioma, hamartoma, lymphangioma, inflammatory pseudotumor, primary splenic tumors, angiosarcoma, lymphoma and metastases. Most lesions are discovered incidentally and most are benign.

Symptoms: Benign lesions often cause none; malignant lesions may be associated with weight loss, fever, night sweats or abnormal blood tests.

Treatment: Typical benign lesions can be monitored. Surgery is considered for diagnostic uncertainty, growth, symptoms, risk of bleeding or suspicion of malignancy.

Splenomegaly and hypersplenism

What it is: Splenomegaly is an enlarged spleen; hypersplenism is excessive removal of blood cells by the spleen, resulting in low platelets, red or white blood cells. Causes include liver disease with portal hypertension, blood disorders, infections and autoimmune diseases.

Symptoms: Heaviness in the upper left abdomen and early satiety; with hypersplenism, fatigue, easy bruising or bleeding.

Treatment: Treatment focuses on the underlying cause. Splenectomy is not usually the first option, but may be discussed for important problems or specific hematological indications.

Hematological conditions that may require splenectomy

What it is: Blood disorders such as ITP, autoimmune hemolytic anemia, hereditary spherocytosis, thalassemia with symptomatic splenomegaly, myelofibrosis and selected leukemias or lymphomas.

Symptoms: Anemia, low platelets, hemolysis, repeated transfusions or pressure from an enlarged spleen; ITP may present with petechiae, bruising or bleeding.

Treatment: Diagnosis and initial treatment are directed by a hematologist. Splenectomy is considered when it may offer a meaningful benefit, for example in persistent or relapsing ITP or in hereditary spherocytosis.

Congenital and anatomical conditions of the spleen

What it is: Wandering spleen and its torsion, accessory spleen, splenogonadal fusion and splenosis.

Symptoms: Often none; torsion of a wandering spleen can cause acute pain and requires urgent assessment.

Treatment: A viable wandering spleen may be fixed in place (splenopexy), while infarction may require splenectomy. An accessory spleen or splenosis usually needs no treatment.

Splenectomy and vaccination

The spleen is not essential for survival, but its absence increases the risk of severe infection from certain bacteria. Before an elective splenectomy, vaccination against pneumococcus, meningococcus and Hib is preferably arranged at least two weeks in advance, and any fever after splenectomy requires prompt medical assessment. In many elective cases, splenectomy can be performed with a minimally invasive technique.

This information is general and does not replace individual medical assessment.