A surgical operation to remove the spleen.

The most common reason to remove the spleen is to control severe bleeding from the organ following serious injury to either the upper abdomen or the lower ribs, both which can happen in a car accident, and is usually performed in an emergency, where it's a lifesaving measure.

It can also be removed for:
Blood diseases like Leukemia, anemia, and thalassemia
venal blood congestion
white blood cell deficiency
Gaucher's Disease
Treatment of ITP (idiopathic thrombocytopenia purpura), a blood disorder involving a deficiency of platelets.

The results vary:
Permanent improvement, such as in hemolytic anemia
a longterm remission of symptoms
provide the basis for the following treatments later, such as for Hodgkin's Disease

The longterm effects are that you can get an infection more easily. Vaccines are reccomended, as well as some surgeoins prescribe Penicillin for an indefinate period after surgery.

The spleen is an organ that lies next to the stomach. One of its functions is to remove worn-out blood cells and foreign particles from circulation; with the lymph nodes, it plays a part in the formation of antibodies. If the spleen is lacerated or ruptured, excessive, uncontrollable hemorrhaging occurs, and the spleen must be removed. Other conditions indicating splenectomy are cancer of the lymph nodes and certain blood disorders. Removal of the spleen does not lead to any permanent disabilities in an adult.

Before the operation, a number of tests including a complete blood count, chest X ray, and electrocardiogram, (EKG) will be performed. Several units of compatible blood will be reserved for a transfusion. An intravenous needle will be inserted into one arm so that fluids can be given to prevent dehydration. One inserted in the other arm will be used for the blood transfusion, if it is needed. One will be given a sedative and a general anesthetic.

After the abdomen is sterilized, an incision will be made through the skin, tissue, and muscle so that the liver, gallbladder, and spleen can be examined. The spleen is separated from surrounding tissues and removed. A portion of the omentum, a fold in the abdominal lining, is sutured over the space, and the incision is closed.

The entire operation takes four to five hours; afterward, one will rest in the recovery room for about the same amount of time. One should try to walk around one’s room the next day; however, strenuous activities should be avoided for about a month. Painkillers will be prescribed. One will also receive a vaccine against pneumonia, since resistance to infection is lowered in persons after splenectomy.

If a wound infection should develop, it will be treated with antibiotics. A scar will be left across the abdomen.

Part of the I blacked out on a bike series start | here | 3 | 4 | 5 | 6 | 7 | 8

Day 1
Thur 8 April, 2004

Left operating theatre 03:30, moved to intensive care bed.

Awoke on the Thursday morning in the intensive therapy unit (ITU). Found myself hooked to endless drips, tubes, lines. Drip into arm; catheter into my bladder, a thick transparent pipe stuck into my side, to drain fluids from the wound, morphine into arm (PCA-patient-controlled analgesia), together with the remnants of lines into my neck and right foot.

Met the doctoring team, led by a very cool man, called Mr Satvinder Mudan**. He told me that I had been lucky to make it. I made some kind of facetious comment saying I’d had complete confidence in them all along. The consultant surgeon gave me a look I’ll never forget, while saying, it was touch and go. “You lost a lot of blood.” He said that about 7 litres of blood spilled out of my abdominal cavity when they opened me up. That was my full count of about five litres, together with a couple of litres of transfused blood. Basically, all the blood in by body had drained away from the ruptured spleen before they opened me up.

**For those who aren't aware of Surgeons' titles, 'Mr." means a fully qualified surgeon, which is as close to the top of the medical tree as you can get. Usually more prestigious than "Dr."

Did little except rest and recover. No food. My wife, children and mother came to visit.

What happened in the operating theatre

I later spoke to one of the surgeons, and he told me what they had done in theatre.

The time I spent in Accident and Emergency was a kind of limbo, waiting for the decision to send me up to theatre. Once the surgical team called in the top consultant, Mr Mudan, he decided to send me to the theatre straight away.

Apparently, all the books say that the spleen is often ruptured in this kind of accident, but there needs to be something to rupture it. That something is almost always a broken rib. Even though the junior surgeons suspected a ruptured spleen, with no broken rib there was no mechanism for how it might have ruptured. And with no way of it rupturing, they were forced, against their instincts, to delay surgical procedures. That was bad news for me.

Except for one thing. The pain in the tip of my shoulder. There is an obscure but well-established link between sensations in the tip of the shoulder and the lymph system. The spleen is a major lymph organ. There was no physical damage to the shoulder, and when I put my finger on the point of pain, the pain reduced a little. I could not localise the damage, so there was something odd going on. The doctors call it transferred pain.

One of my doctoring friends, I later discovered, recognised this connection immediately, but the doctors in accident and emergency did not. Eventually, as more senior doctors became involved, they made the connection between spleen and shoulder. Also, the junior doctors did not have experience of enough accidents. The more senior ones had seen cases where the whole rib cage collapsed elastically, trapping organs** between the front and back ribs, and then springing back to a more conventional shape.

**Apparently the only other case of overly-elastic ribs that my surgeon had seen was where the patient's heart got crushed between the ribs. The patient did not survive.

So, they got to the diagnosis through the shoulder-tip. The more senior doctors found the mechanism: bendy ribs. And they had a very sick patient. I was rushed to theatre, with severe internal bleeding, extremely low haemo count and plummeting blood pressure.

Once up there, I was fairly quickly put under anaesthetic. I don’t remember anything more, until I woke the following day in intensive care, stuck like a pincushion full of tubes and lines.

What happened in theatre was, apparently a bit touch and go. I was very fortunate, first of all, that Mr Mudan himself was in charge of the operation.

When they opened me up, apparently, around seven litres of blood spilled out of my abdominal cavity. The average adult carries about 5 litres of blood in their system. I had already had a number of transfusions, so it appears that there was very little blood left to be pumped around my body, and I understand that this caused some concern among the medical team.

Once that had been cleaned up, they got through to my spleen, where they found it damaged in two places, one small tear and another tear all the way across the organ. They repaired the first tear and tried to repair the second, first by stitching, and next by a kind of spray-on adhesive. These and several other attempts failed, so they tried to save a part of the organ, but in the end were unable to do that, and so removed the whole organ, before having a quick check around the rest of my abdomen and then finally putting me back together again.

One of the tools of the surgical trade is a cauterizing tool. This uses heat, generated electrically, to burn sources of bleeding. It seals up the leaks in a sterile way, and it appears they were using it fairly liberally inside me. At some point during the operation, this tool fell onto my left thigh, causing a large electrical burn. It is still far from healed, over two weeks later. I suspect it will leave a good-sized scar. One year on, there is an oval scar, two inches long and an inch wide.

The main surgical scar, however, reaches from my sternum (the lowest point of the rib cage) to just below my navel. It is not exactly down the middle, but slightly askew. I think my modelling days are over.

The ‘stitches’ which held the main incision together, were in fact staples. Pieces of wire bent around into a rectangular shape, piercing the skin on either side of the scalpel cut. The cut is about 150 mm (six inches) long, and one year on has healed completely, leaving only a dull purple line down my midriff. When the nurse removed the staples, she used a special tool which both gripped the wire and bent the two ends outwards, so that the whole staple came out with a small twist and very little pain.

Before finally closing me up, they inserted a drain—a piece of plastic hosepipe—into the abdominal cavity, to drain away any spare blood that might leak out of any organs during the recovery phase. It turns out that the hose extended into me by some 150 mm, so that when I turned over in my sleep, it swirled round inside me, leading to some interesting sensations and no small discomfort in the night.



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