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The spleen is protected by the rib cage, but it is still the organ most likely to be injured by a blunt force blow to the abdomen. About 25 percent of admissions to emergency rooms for blows to the abdomen reveal injuries of the spleen. The spleen only weighs 75 to 100 grams (a little under three to a little over four ounces), but 10 to 15 percent of the body's entire supply of blood passes through the spleen every minute, so injuries to the spleen can result in serious or even fatal internal bleeding demanding surgical treatment.

What are the symptoms of an injury to the spleen?

  • Minor injury to the spleen may cause dull pain in the upper left quadrant of the abdomen. This pain may shoot up to the left shoulder.
  • Major injury to the spleen may cause "belly bloat" and "changes in color" that at first only close friends and members of the family would notice. The heart rate may be elevated. Breathing may be faster and more labored. The person who has the injury may report a "sense of doom," or anxiety without any obvious reason. A gentle poke at the abdomen may be painful. Symptoms may get worse very quickly at some point, including dizziness when moving from a seated position to a standing position or even complete loss of consciousness.

Doctors usually diagnose spleen injuries with a CT scan using contrast dye. CT scans enable the doctor to examine all of the abdominal organs at once and look for secondary injuries. 

Spleen injuries are much less common than a condition called splenomegaly, in which the spleen is enlarged. Up to 1 in 20 people will have this condition at some point in life. Spleen enlargements can be due to:

  • Capture of fragments of red blood cells or misshapen red blood cells, usually in people who have sickle cell disease or malaria, or who have suffered traumatic injuries elsewhere in the body.
  • Capture of white blood cells after long-term infection.
  • Capture of microorganisms after long-term infection.
  • In very rare cases, cancer.

There are a variety of usually vague symptoms that go along with splenomegaly. There can be pain under the lower left rib cage. The spleen may swell to five or six or more times its normal size, so large that it can be felt during a physical exam of the abdomen. When splenomegaly is due to a blood disorder, there may be easy bruising or pale skin. When the problem affects the pancreas, there maybe the symptoms of pancreatitis, including diarrhea after eating fatty food and intense abdominal pain after eating. (These are also symptoms of other diseases.) If the spleen can't do its job of removing microorganisms from the bloodstream, there will be more cold, flu, and sinus problems.

An astonishing number of conditions can cause symptoms similar to splenomegaly. These include familial high cholesterol, tuberculosis, congestive heart failure, mononucleosis, infections of the lining of the heart, a parasitic condition called trypanosomiasis, typhoid, thalassemia, malaria, another parasitic condition called schistosomiasis, leukemia, sarcoidosis, and infection of the spleen itself. The doctor has to rule out these conditions to make a diagnosis of enlarged spleen.

If the problem is enlarged spleen, however, then more often than not the treatment is surgery. Most of the time the spleen can be removed by laparoscopic ("keyhole") surgery. A major complication of surgery can be the accumulation of the broken blood cells that the spleen would otherwise have removed from circulation. Since one of the spleen's tasks is removing bacteria from the bloodstream, infections can become a problem after the spleen is removed. 

There really aren't any good alternatives to surgery. If for some reason you just can't have surgery, the best you will be able to do is to manage your symptoms. Get a clear diagnosis of your medical issue, and then work with your hospital's financial office to figure out ways to get you the surgery you need, if you need it.

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