Splenectomy
Encyclopedia
A splenectomy is a surgical procedure
that partially or completely removes the spleen
.
, acts as a blood filter. Current knowledge of its purpose includes the removal of old red blood cell
s and platelet
s, and the detection and fight against certain bacteria. It is also known to function as a site for the development of new red blood cells from their hematopoietic stem cell precursors, and particularly in situations in which the bone marrow
, the normal site for this process, has been compromised by a disorder such as leukemia
. The spleen is enlarged in a variety of conditions such as malaria
, mononucleosis
and most commonly in "cancers" of the lymphatic
s, such as lymphoma
s or leukemia
.
It is removed under the following circumstances:
The classical cause of traumatic damage to the spleen is a blow to the abdomen during a sporting event. In cases where the spleen is enlarged due to illness (mononucleosis), trivial activities, such as leaning over a counter or straining while defecating, can cause a rupture.
is the preferred procedure in cases where the spleen is not too large and when the procedure is elective. Open surgery is performed in trauma cases or if the spleen is enlarged. Either method is major surgery and is performed under general anesthesia. Vaccination for pneumococcus, H. influenza and meningococcus should be given pre-operatively if possible to minimize the chance of overwhelming post-splenectomy infection
(OPSI), a rapid-developing and potentially fatal type of septicaemia. The spleen is located and disconnected from its arteries. The ligaments holding the spleen in place are dissected and the organ is removed. In some cases, one or more accessory spleen
s are discovered and also removed during surgery. The incisions are closed and when indicated, a drain is left. If necessary, tissue samples are sent to a laboratory for analysis.
due to encapsulated organisms (such as S. pneumoniae and Haemophilus influenzae
) the patient should receive the pneumococcal conjugate vaccine (Prevnar), Hib vaccine
, and the meningococcal vaccine
; see asplenia
. These bacteria often cause a sore throat under normal circumstances but after splenectomy, when infecting bacteria cannot be adequately opsonized, the infection becomes more severe.
An increase in blood leukocytes can occur following a splenectomy. The post-splenectomy platelet
count may rise to abnormally high levels (thrombocytosis
), leading to an increased risk of potentially fatal clot formation. There also is some conjecture that post-splenectomy patients may be at elevated risk of subsequently developing diabetes. Splenectomy may also lead to chronic neutrophilia
. Splenectomy patients typically have Heinz bodies in their blood smears
.
In particular, whilst vaccination and antibiotics provide good protection against the risks of asplenia, this is not always available in poorer countries. However as it may take some time for the preserved splenic tissue to provide the full protection, it has been advised that preoperative vaccination still be given.
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
that partially or completely removes the spleen
Spleen
The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...
.
Indications
The spleen, similar in structure to a large lymph nodeLymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
, acts as a blood filter. Current knowledge of its purpose includes the removal of old red blood cell
Red blood cell
Red blood cells are the most common type of blood cell and the vertebrate organism's principal means of delivering oxygen to the body tissues via the blood flow through the circulatory system...
s and platelet
Platelet
Platelets, or thrombocytes , are small,irregularly shaped clear cell fragments , 2–3 µm in diameter, which are derived from fragmentation of precursor megakaryocytes. The average lifespan of a platelet is normally just 5 to 9 days...
s, and the detection and fight against certain bacteria. It is also known to function as a site for the development of new red blood cells from their hematopoietic stem cell precursors, and particularly in situations in which the bone marrow
Bone marrow
Bone marrow is the flexible tissue found in the interior of bones. In humans, bone marrow in large bones produces new blood cells. On average, bone marrow constitutes 4% of the total body mass of humans; in adults weighing 65 kg , bone marrow accounts for approximately 2.6 kg...
, the normal site for this process, has been compromised by a disorder such as leukemia
Leukemia
Leukemia or leukaemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases...
. The spleen is enlarged in a variety of conditions such as malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
, mononucleosis
Infectious mononucleosis
Infectious mononucleosis is an infectious, widespread viral...
and most commonly in "cancers" of the lymphatic
Lymphatic system
The lymphoid system is the part of the immune system comprising a network of conduits called lymphatic vessels that carry a clear fluid called lymph unidirectionally toward the heart. Lymphoid tissue is found in many organs, particularly the lymph nodes, and in the lymphoid follicles associated...
s, such as lymphoma
Lymphoma
Lymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
s or leukemia
Leukemia
Leukemia or leukaemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases...
.
It is removed under the following circumstances:
- When it becomes very large such that it becomes destructive to plateletPlateletPlatelets, or thrombocytes , are small,irregularly shaped clear cell fragments , 2–3 µm in diameter, which are derived from fragmentation of precursor megakaryocytes. The average lifespan of a platelet is normally just 5 to 9 days...
s/red blood cells - For diagnosing certain lymphomaLymphomaLymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
s - Certain cases of wandering spleenWandering spleenWandering spleen is a rare medical disease caused by the loss or weakening of the ligaments that help to hold the spleen.-Background:...
- When platelets are destroyed in the spleen as a result of an auto-immune process (see also idiopathic thrombocytopenic purpuraIdiopathic thrombocytopenic purpuraIdiopathic thrombocytopenic purpura is the condition of having an abnormally low platelet count of no known cause . As most incidents of ITP appear to be related to the production of antibodies against platelets, immune thrombocytopenic purpura or immune thrombocytopenia are terms also used to...
) - When the spleen bleeds following physical traumaPhysical traumaTrauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
- Following spontaneous ruptureRuptured spleenRupture of the capsule of the spleen, an organ in the upper left part of the abdomen, is a situation that requires immediate medical attention. The rupture of a normal spleen can be caused by trauma, such as a car accident.-Function In the Body:...
- For long-term treatment of congenital erythropoietic porphyriaPorphyriaPorphyrias are a group of inherited or acquired disorders of certain enzymes in the heme bio-synthetic pathway . They are broadly classified as acute porphyrias and cutaneous porphyrias, based on the site of the overproduction and accumulation of the porphyrins...
(CEP) if severe hemolytic anemiaHemolytic anemiaHemolytic anemia is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells , either in the blood vessels or elsewhere in the human body . It has numerous possible causes, ranging from relatively harmless to life-threatening...
develops - The spread of gastric cancer to splenic tissue
- When using the splenic arterySplenic arteryIn anatomy, the splenic artery is the blood vessel that supplies oxygenated blood to the spleen. It branches from the celiac artery, and follows a course superior to the pancreas.-Branches:...
for kidney revascularisation in renovascular hypertensionRenovascular hypertensionRenovascular hypertension is a syndrome which consists of high blood pressure caused by narrowing of the arteries supplying the kidneys...
. - For long-term treatment of congenital pyruvate kinase (PK) deficiency
The classical cause of traumatic damage to the spleen is a blow to the abdomen during a sporting event. In cases where the spleen is enlarged due to illness (mononucleosis), trivial activities, such as leaning over a counter or straining while defecating, can cause a rupture.
Procedure
LaparoscopyLaparoscopy
Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera...
is the preferred procedure in cases where the spleen is not too large and when the procedure is elective. Open surgery is performed in trauma cases or if the spleen is enlarged. Either method is major surgery and is performed under general anesthesia. Vaccination for pneumococcus, H. influenza and meningococcus should be given pre-operatively if possible to minimize the chance of overwhelming post-splenectomy infection
Overwhelming post-splenectomy infection
An overwhelming post-splenectomy infection is a rare but rapidly fatal infection occurring in individuals following removal of the spleen...
(OPSI), a rapid-developing and potentially fatal type of septicaemia. The spleen is located and disconnected from its arteries. The ligaments holding the spleen in place are dissected and the organ is removed. In some cases, one or more accessory spleen
Accessory spleen
An accessory spleen is a small nodule of splenic tissue found apart from the main body of the spleen. Accessory spleens are found in approximately 10 percent of the population and are typically around 1 centimeter in diameter. They form either by the result of developmental anomalies or trauma...
s are discovered and also removed during surgery. The incisions are closed and when indicated, a drain is left. If necessary, tissue samples are sent to a laboratory for analysis.
Side effects
As splenectomy causes an increased risk of sepsisSepsis
Sepsis is a potentially deadly medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues...
due to encapsulated organisms (such as S. pneumoniae and Haemophilus influenzae
Haemophilus influenzae
Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, Gram-negative, rod-shaped bacterium first described in 1892 by Richard Pfeiffer during an influenza pandemic. A member of the Pasteurellaceae family, it is generally aerobic, but can grow as a facultative anaerobe. H...
) the patient should receive the pneumococcal conjugate vaccine (Prevnar), Hib vaccine
Hib vaccine
Haemophilus influenzae type B vaccine is a conjugate vaccine developed for the prevention of invasive disease caused by Haemophilus influenzae type b bacteria. The Centers for Disease Control and Prevention has recommended the use of the Hib vaccine. Due to routine use of the Hib vaccine in...
, and the meningococcal vaccine
Meningococcal vaccine
Meningococcal vaccine is a vaccine used against Meningococcus, a bacterium that causes meningitis, meningococcemia, septicemia, and rarely carditis, septic arthritis, or pneumonia.-Types:...
; see asplenia
Asplenia
Asplenia refers to the absence of normal spleen function and is associated with some serious infection risks. Hyposplenism is used to describe reduced splenic functioning, but not as severely affected as with asplenism.-Congenital:...
. These bacteria often cause a sore throat under normal circumstances but after splenectomy, when infecting bacteria cannot be adequately opsonized, the infection becomes more severe.
An increase in blood leukocytes can occur following a splenectomy. The post-splenectomy platelet
Platelet
Platelets, or thrombocytes , are small,irregularly shaped clear cell fragments , 2–3 µm in diameter, which are derived from fragmentation of precursor megakaryocytes. The average lifespan of a platelet is normally just 5 to 9 days...
count may rise to abnormally high levels (thrombocytosis
Thrombocytosis
Thrombocytosis is the presence of high platelet counts in the blood, and can be either primary or reactive...
), leading to an increased risk of potentially fatal clot formation. There also is some conjecture that post-splenectomy patients may be at elevated risk of subsequently developing diabetes. Splenectomy may also lead to chronic neutrophilia
Neutrophilia
Neutrophilia is a condition where a person has a high number of neutrophil granulocytes in their blood.-Causes:...
. Splenectomy patients typically have Heinz bodies in their blood smears
Partial splenectomy
Much of the spleen's protective roles can be maintained if a small amount of spleen can be left behind. Where clinically appropriate, attempts are now often made to perform either surgical subtotal (partial) splenectomy, or partial splenic embolizationEmbolization
Embolization is a non-surgical, minimally-invasive procedure performed by an interventional radiologist and interventional neuroradiologists. It involves the selective occlusion of blood vessels by purposely introducing emboli.-Therapeutic applications:...
.
In particular, whilst vaccination and antibiotics provide good protection against the risks of asplenia, this is not always available in poorer countries. However as it may take some time for the preserved splenic tissue to provide the full protection, it has been advised that preoperative vaccination still be given.