The spleen is a fist-sized organ under the left ribs that filters blood, removes old red cells and helps fight certain bacteria. Spleen disorders include an enlarged spleen (splenomegaly), an overactive spleen that removes too many blood cells (hypersplenism), cysts, abscesses, infarcts, rupture, and a spleen that is absent or does not function.
An enlarged spleen is nearly always a sign of something else, such as liver disease, a blood disorder or infection, so treatment is directed at that cause. Removal of the spleen is reserved for specific situations, because life without a spleen carries a permanent, though manageable, infection risk.
Symptoms
- Often none: enlargement is found on examination or a scan
- Fullness or pain under the left ribs, sometimes felt in the left shoulder
- Feeling full after a small meal because the spleen presses on the stomach
- Tiredness and pallor from anaemia
- Frequent infections
- Easy bruising or bleeding from low platelets
- Sudden severe left-sided pain after an injury
Causes and risk factors
Causes of enlargement fall into groups. Congestion from cirrhosis and portal or splenic vein clots. Blood disorders: hereditary spherocytosis, thalassaemia, sickle cell disease in childhood, autoimmune haemolysis, leukaemias, lymphomas and myelofibrosis. Infections: glandular fever, malaria, visceral leishmaniasis, endocarditis, tuberculosis and brucellosis. Inflammatory and storage conditions: lupus, sarcoidosis, Gaucher disease. Cysts may be congenital, post-traumatic or hydatid. Loss of function follows surgical removal, sickle cell disease and, less commonly, coeliac disease.
How it is diagnosed
- Physical examination: A normal spleen cannot be felt. One that can is usually at least twice its normal size. Liver signs and lymph nodes are checked at the same time.
- Blood count and blood film: Low counts suggest hypersplenism or marrow disease. The film can show abnormal cells, parasites, or the Howell-Jolly bodies of a non-functioning spleen.
- Ultrasound: Measures the spleen, normally up to about 12 to 13 cm long, and shows cysts, focal lesions and portal vein flow.
- CT or MRI: Defines masses, infarcts, abscesses and injury, and looks for enlarged lymph nodes.
- Further blood tests: Liver function, haemolysis screen, viral and other infection tests, and autoimmune markers, directed by the clinical picture.
- Bone marrow or lymph node biopsy: When a blood cancer is suspected. Biopsy of the spleen itself is rarely done because of bleeding risk.
Treatment options
- Treating the underlying disease: Antivirals or other liver care, treatment of infection, steroids or other therapy for immune conditions, and haematology treatment for blood cancers often shrink the spleen.
- Observation: Mild enlargement without low counts, and small simple cysts, are usually just monitored.
- Splenectomy: Removal, usually laparoscopic, for hereditary spherocytosis, immune thrombocytopenia that fails medical therapy, some lymphomas, large symptomatic cysts, abscess or rupture. Hospital stay is typically 2 to 4 days.
- Partial splenectomy and cyst surgery: Preserve some splenic function, particularly in children and for benign cysts.
- Splenic artery embolisation: A radiological alternative to surgery in selected injuries and in hypersplenism.
- Protection after splenectomy: Pneumococcal, meningococcal, Haemophilus and yearly flu vaccines, ideally at least 2 weeks before planned surgery, with standby or long-term antibiotics and a medical alert card.
When it is urgent
Call emergency services locally for sudden severe pain in the upper left abdomen or left shoulder tip, particularly after a blow, fall or during glandular fever, with dizziness, pallor or a fast pulse, which suggests a ruptured spleen. Anyone without a working spleen who develops fever or shivering should take their standby antibiotic if prescribed and go to hospital at once.
Travelling to Türkiye for treatment
A visit can provide a focused work-up of an unexplained enlarged spleen with blood tests, imaging and haematology review over several days, or a planned laparoscopic splenectomy or cyst operation with about 7 to 10 days in the city. Vaccines should be completed before surgery. People without a spleen need specific advice on malaria and on animal and tick bites before travelling anywhere, as these infections can be severe.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Can I live normally without a spleen?
Yes. Other organs take over most of its work. The lasting issue is a small risk of overwhelming bacterial infection, which vaccines, antibiotics and prompt attention to fever reduce.
Can I play sport with an enlarged spleen?
Avoid contact and collision sports while it is enlarged, because a big spleen is easier to rupture. After glandular fever, the usual advice is to wait at least 3 to 4 weeks, longer for contact sport.
Does an enlarged spleen mean cancer?
Not usually. Liver disease and infections are more common causes. Blood cancers are one possibility, which is why a blood count and film are done early.