Indications of splenectomy
Generally speaking, the spleen is removed for 2 main causes which are either trauma that caused the spleen to rupture or a blood disorder that is directly or indirectly linked to the spleen.
1) Ruptured spleen
Splenic rupture can result from a sharp penetrating object at the left upper abdomen or the left lower chest or from a blunt injury that either damaged the spleen directly or caused a rib fracture that acted as a secondary sharp object and lacerated the spleen. Regardless of the injury, if the spleen is injured enough, profuse bleeding can occur in the abdomen which can be life-threatening. The patient is first managed conservatively, and surgery is only resorted to if conservative measures prove unsuccessful or if the patient developed a severe drop of blood pressure.
Another less invasive method includes interventional radiology, where we use a catheter to inject a material into the splenic artery occluding it and effectively stopping bleeding. This procedure, however, needs expert hands and a stable patient. Surgery is reserved because operating on a patient with a low blood pressure and profuse bleeding tends to be hazardous and success rates are low. It is worth noting, however, that not all surgeries done for splenic rupture are splenectomies, and various methods to conserve the spleen are present and are increasingly being used nowadays. The main determinants of whether a splenic preservation approach should be followed is the degree of splenic damage as well as the surgeon’s expertise and judgement.