The spleen is a spongy, soft organ that is about as big as a person's fist, and is located in the upper left part of the abdomen, just under the rib cage. The splenic artery brings blood to the spleen from the heart. Blood leaves the spleen through the splenic vein, which drains into a larger vein (the portal vein) that carries the blood to the liver. Spleens vary in size, ranging from 6 to 16 centimeters in length in healthy human adults.

The spleen functions in the mechanical filtration of red blood cells, the destruction of redundant (extra) and old red blood cells and platelets, and also holds a reservoir of stored extra platelets for the body's use in case of an emergency. The spleen is also an important part of the immune system. Its immune functions include destroying bacteria and producing antibodies. Its absence leads to an increased likelihood of contracting certain infections.

What diseases of the spleen does a surgeon see?

The three most common splenic conditions that our surgeons see are:

Splenic Rupture: One of the most common indications for splenectomy (surgical removal of the spleen) has been trauma to the spleen. Rupture of a normal spleen can be caused by trauma, for example, in an accident. Splenic rupture permits large amounts of blood to leak into the abdominal cavity. It is severely painful and can be life-threatening. Shock and, ultimately, death can result. Patients can require an urgent operation to remove the spleen and stop the bleeding, although it is becoming increasingly common in recent years to monitor the patient, see if the bleeding stops by itself, and if it does, allow the spleen to heal by itself.

Splenic Artery Aneurysm: Splenic artery aneurysms occur in less than 1% of the population and are usually incidental findings (meaning they are found by accident). They are more common in women than in men. It is important that once found, splenic artery aneurysms be treated because rupture of the aneurysm carries a substantial risk of mortality (death).

Idiopathic Thrombocytopenic Purpura (ITP): Recent data suggests that ITP is now the most frequent indication for splenectomy in the elective setting. Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood does not clot as it should. This is due to a low number of blood cells called platelets. Idiopathic means that the cause of the disease or condition isn't known. Thrombocytopenic means there is a lower-than-normal number of platelets in the blood. Purpura are purple bruises caused by bleeding under the skin. In most cases, the body's immune system is thought to cause ITP.

There are many other indications for removal of the spleen, although they are less commonly seen. These include disorders of the red blood cells, myeloproliferative disorders, white blood cells, platelets, hereditary spherocytosis, autoimmune hemolytic anemia, thrombotic thrombocytopenic purpura, and lesions. The spleen also can be removed for the purpose of staging (determining the advancement of) Hodgkin's disease.

What are the symptoms of spleen disease?

Symptoms of a ruptured spleen include abdominal pain, hypotension (low blood pressure), and tachycardia (rapid heartbeat). When the spleen is injured, blood is released into the abdomen. The amount of bleeding depends on the size of the injury.

The only symptom of a splenic artery aneurysm is abdominal pain. Abdominal pain is present in approximately one-quarter of splenic artery aneurysm cases.

People who have ITP often have purple bruises that appear on the skin or on the mucous membranes (for example, in the mouth). A person who has ITP also may have bleeding that results in tiny red or purple dots on the skin. These dots, often seen on the lower legs, are called petechiae. Petechiae may look like a rash. People with ITP may have nosebleeds, bleeding from the gums when they have dental work done, or other bleeding that's hard to stop. Women with ITP may have heavy menstrual bleeding. Bleeding in the brain as a result of ITP is very rare, but can be life threatening if it occurs.

How is spleen disease diagnosed?

Ultrasound and CT Scans are used to diagnose a ruptured spleen. They will detect the presence of blood in the abdominal cavity that is characteristic of a ruptured spleen. A splenic artery aneurysm can also be diagnosed by CT Scan. MRA may also be useful in the diagnosis of splenic artery aneurysms. ITP is usually diagnosed by blood tests and sometimes bone marrow examinations. The blood tests look for a low platelet count.

How is spleen disease treated?

Diseases of the spleen are usually treated by splenectomy (surgical removal of the spleen). This can sometimes be done laparoscopically. However, in most cases, the patient will need to stay the night in the hospital. In certain cases of splenic rupture, if the rupture is small, surgeons are sometimes able to repair a small tear. Also, certain splenic artery aneurysms can be treated by a minimally invasive procedure called embolization, rather than splenectomy.

People can live without a spleen. The spleen is a helpful organ but not necessary. When the spleen is removed, the body loses some of its ability to produce protective antibodies and to remove unwanted microorganisms from the blood. As a result, the body's ability to fight infections is impaired. People who have undergone splenectomy may receive vaccinations to help protect them from infection. Yearly vaccinations against influenza are also recommended after a splenectomy. Some people take antibiotics to prevent infections.