The procedure of splenectomy involves removal of the spleen by
operative means. The spleen, a large lymph node, has historically held
rather a mythical role but current knowledge of its purpose includes
the destruction of old red cells and platelets and the detection and
fight against certain bacteria.
The spleen is enlarged in a variety of conditions such as malaria,
glandular fever and most commonly in "cancers" of the lymphatics such
as lymphomas or the leukaemia.
It is removed under the following circumstances:
- When very large and become destructive to platelets/red cells
- For diagnosing certain lymphomas
- When platelets are destroyed in the spleen as a result of an
- When the spleen bleeds following trauma
- Following spontaneous rupture
The classical cause of traumatic damage to the spleen is a motorcycle
accident where one end of the handlebars strikes the abdomen.
In general, spleens are removed by laparoscopy (minimal access
surgery) when the spleen is not too large and when the procedure is
elective. It is performed by open surgery for trauma or large spleens.
Because splenectomy causes an increased risk of overwhelming sepsis
due to encapsulated organisms (such as S. pneumoniae and Haemophilus
influenzae) the patient should be immunized, if possible, prior to
removal of the spleen. Failure to do so puts the patient post
splenectomy to a condition called OPSI (overwhelming post splenectomy
infection). 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.
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Following splenectomy, the platelet count may rise to high levels in
blood leading to an increased risk of clot formation.