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Spleen Removal - Everything You Should Know About It!

Definition - what is spleen removal?

The so-called splenectomy describes the removal of the spleen or parts of the organ. Such a removal of the spleen may be necessary in the case of an injury to the spleen as a result of an accident or in the case of some internal diseases. The latter include, in particular, dangerous functional disorders of the spleen or diseases in which the spleen is considerably enlarged and thus there is an increased risk of the organ spontaneously "bursting".

How complicated the operation is when removing a spleen depends heavily on whether it is an emergency operation following an accident or a scheduled operation.

Irrespective of this, however, the removal of the spleen has some disadvantages, which primarily include an increased tendency to thrombosis and an increased susceptibility to infection. For this reason, follow-up treatment is of great importance for the long-term success of a spleen removal.

causes

The most common cause of spleen removal is injury to the spleen as a result of an accident. Since the spleen is very well supplied with blood, accidental injuries to the organ are accompanied by massive blood loss. This life-threatening situation requires immediate, effective action to stop the bleeding - there is simply no time to reconstruct or sew the injured spleen, it has to be removed immediately and the severed blood vessels closed.
Read here on the topic: Ruptured spleen

In addition, various internal diseases can be the cause of a spleen removal. What many of these diseases have in common is that they are accompanied by a strong enlargement of the spleen. As the spleen grows, so does the risk of a spontaneous rupture of the spleen (rupture of the spleen), meaning that the organ will simply "burst".

Since this, like a rupture of the spleen caused by an accident, would result in life-threatening blood loss, a precautionary removal of the spleen must be considered if the enlargement is certain. These include, for example, tumors or abscesses (spleen abscess, encapsulated collections of pus), but also some haematological diseases such as B. thalassemias, sickle cell anemia, ITP (Werlhof's disease) and TTP (Moschcowitz syndrome).

What are the short and long-term consequences of having a spleen removed?

Even during their inpatient hospital stay, quite a few sufferers develop pneumonia or other complaints in the respiratory system. On the one hand, this is due to the fact that the spleen is significantly involved in storing and multiplying various defense cells of the immune system. If the spleen is now removed, this limits the functionality of the immune system, at least temporarily, and potential pathogens have an easy time of it.

The increased susceptibility to infection is put into perspective after a few weeks, but remains higher for life. It can sometimes represent a considerable impairment of the quality of life: Every fever after a spleen removal can theoretically be a harbinger of life-threatening sepsis ("blood poisoning", complex inflammatory reaction of the entire body) and therefore requires immediate medical attention and the initiation of antibiotic therapy.

Various vaccinations are recommended to reduce the risk of such serious consequences of spleen removal. In addition, antibiotic prophylaxis can be considered in the first two years after the removal of the spleen, for example in the form of taking penicillin twice a day.

In addition to participating in the immune system, the breakdown of older blood platelets (thrombocytes) is one of the main tasks of the spleen. Since the platelets are an essential part of hemostasis, removing the spleen increases the risk of blood clots forming (e.g. portal vein thrombosis, leg vein thrombosis, pulmonary embolism). Before deciding whether to initiate drug-based thrombosis prophylaxis, an individual analysis of the risk-benefit ratio must be carried out: the drugs used reduce the risk of thromboembolic events, but also increase the risk of bleeding. If one finally decides on such prophylaxis, in most cases heparin is used in the first few weeks and then acetylsalicylic acid (ASA) permanently.

Here you can find out more about the topic: Detecting thrombosis!

Accompanying symptoms after a spleen removal

The removal of the spleen itself does not cause any symptoms, apart from the pain in the wound area after the operation.

However, the restricted functionality of the immune system as a result of the removal of the spleen increases the risk of severe infectious diseases. These sometimes life-threatening disease courses are known as OPSI (overwhelming post-splenectomy infection).

As a result, any fever or even any fever-free systemic disease of the body can potentially be the starting point for such a life-threatening infection. In addition to the fever, abdominal pain, a fast heartbeat and generally all flu symptoms (cough, runny nose, headache, body aches) should also be mentioned as early symptoms of OPSI. If one or more of these symptoms occur after a spleen has been removed, a doctor should be consulted immediately, who can initiate appropriate antibiotic therapy if necessary.

The thromboembolic events (portal vein thrombosis, leg vein thrombosis, pulmonary embolism), which also occur frequently after a spleen has been removed, often take place over a long period of time without any symptoms and are then suddenly noticeable.

While vomiting with blood after removal of the spleen suggests portal vein thrombosis, leg vein thrombosis usually manifests itself in the form of pain, reddening, overheating and swelling of the affected leg.

Pulmonary embolism, which is usually based on a leg vein thrombosis, causes coughing, chest pain, increased heart rate and shortness of breath.

Treatment and therapy of the consequences

If an infection occurs after the spleen has been removed, there is always the risk of a serious disease course (OPSI) due to the missing spleen. The body then has to be supported in its fight against the pathogens. Antibiotic therapy should be initiated immediately, mostly in the form of ceftriaxone, possibly in combination with vancomycin.

Depending on the urgency, the active ingredients can either be administered via a venous cannula (faster onset of action) or as a tablet. After the spleen has been removed, some people also receive an antibiotic to take home with them, which they can then take even if they have a fever or other systemic illness (e.g. amoxicillin or levofloxacin). However, this requires appropriate training of the patient.

If a thromboembolic event occurs as a result of the removal of the spleen, such as a leg vein thrombosis, this is usually treated with medication. Therapy then consists of heparin preparations or so-called factor X inhibitors (e.g. rivaroxaban or fondaparinux).

After the acute therapy, relapse prophylaxis in the form of coumarin derivatives (e.g. Marcumar®) is initiated over a period of several months. In the case of pulmonary embolism, drug lysis (dissolution of the blood clot) or surgical removal of the clot may also be necessary.

What complications can there be after removing a spleen?

When it comes to complications following splenectomy, the respiratory system is most commonly affected. Due to the increased susceptibility to infections, repeated inflammations of the lungs (pneumonia) can occur, and pleural effusions (fluid accumulation in the gap between the chest wall and the lungs) can occur.

In about one in a hundred patients, a so-called pancreatic fistula develops as a result of the removal of the spleen, i.e. a tube-like connection between the pancreas and the intestine or the abdominal cavity. Since the spleen is also responsible for breaking down the thrombocytes (blood platelets), thromboembolic events such as portal vein or leg vein thrombosis occur more frequently after the spleen has been removed.

How long does it take to have a spleen removed in the hospital?

Obviously, no general statement can be made about the exact length of stay in the hospital after the spleen has been removed. The individual requirements (age, secondary diseases, reason for the removal of the spleen) are simply too different for this.

In addition, every patient reacts differently to the operation, for example in terms of pain. However, professional monitoring of the surgical wounds and possible internal and surgical complications is of great importance for the healing process and long-term success of the spleen removal.

For this reason, you have to assume that even in the worst case scenario, you will have to spend at least five days in the hospital. The length of stay may occasionally exceed two weeks only in exceptional cases and in the case of complicated processes; a period of 1 to 2 weeks should be estimated for the majority of patients.

So don't lose patience if your surgeon cannot tell you the exact time of discharge before or immediately after the operation. This only shows that he wants to monitor the development of your physical condition after the operation and make your discharge dependent on the healing process.

What is the diet after removal of the spleen?

However, since the body is generally more susceptible to infections after a spleen has been removed, it is more important than ever to eat a healthy and balanced diet. Fruit and vegetables should therefore be found on the meal plan all the more urgently.

Otherwise, there are no special rules or prohibitions on nutrition after a spleen has been removed, as the spleen does not play an essential role in the nutrient or mineral balance.

Which vaccinations should you have after a spleen removal?

Three vaccinations are considered absolutely essential after a spleen has been removed, namely the vaccinations against pneumococci, meningococci and Haemophilus influenzae B.

This is due to the fact that affected patients have a considerably higher risk of an infection with one of the pathogens mentioned being serious or even fatal. That is why preventing such an infection is particularly important for them and the best way to do this is by vaccination.

As a rule, all three of these vaccinations can be given on the same day. If the removal of the spleen is a planned and not an emergency operation, the vaccinations should be given at least two weeks before the operation if possible. If not otherwise possible, they can also be done up to three days before the operation. In addition, after removing a spleen, it is strongly advised to have an annual flu vaccination.

Spleen removal and alcohol - are they compatible?

Since the spleen is not involved in the breakdown of alcohol, there is nothing against the occasional, moderate consumption of alcohol even after the spleen has been removed. However, after a spleen has been removed, the liver takes over part of the tasks of the spleen, which is why it should be spared as much as possible.

Excessive, regular alcohol consumption should therefore be an even bigger taboo in this situation than in general! In addition, excessive alcohol consumption affects the body's defenses, which is particularly unfavorable after a spleen has been removed, as those affected are already more susceptible to infections.

After a spleen has been removed, the following applies: As long as you don't overdo it, you can enjoy your occasional after-work beer or a glass of your favorite wine with a clear conscience.

Surgical procedure for removing a spleen

At the beginning of the splenectomy (spleen removal) performed under general anesthesia, a so-called laparotomy is performed, i.e. the abdominal cavity is opened. In the case of a planned operation, an arc-shaped incision is usually made on the lower edge of the left costal arch, while in emergency operations the incision is usually made in the middle of the upper abdomen.

After a ligament connecting the intestine and stomach has been severed, the left bowel arch is exposed. This is connected to the spleen via another connecting band, which must also be overcome. The surgeon then cuts the blood vessels in the spleen and clamps them off. The organ can then be dissected out of the surrounding tissue and finally removed. At the end of the operation, the drains are placed and finally the incisions are sewn shut.