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The spleen is a solid organ about the size of your hand, which is located under the diaphragm in the left upper part of the abdomen. It acts mostly as a blood filter, identifying and destroying old worn out blood cells. It also helps the immune system to identify and respond to certain types of bacteria in the blood stream. The most common surgical problem involving the spleen is rupture causing internal bleeding. Usually this is due to some type of trauma, like a motor vehicle accident or a sporting injury. Sometimes the spleen can grow very large in response to infections like Mononucleosis or in response to problems that affect blood flow through the spleen. Significant enlargement of the spleen, called splenomegaly, can make the spleen much more susceptible to traumatic rupture. The spleen can also cause problems if it destroys too many blood cells, particularly the cell fragments called Platelets, which are critical to blood clotting. This is precisely what happens in the condition known as Idiopathic Thrombocytopenia Purpura, or ITP.
The body normally produces tiny cell fragments called platelets, which are extremely important in the process of blood coagulation. Patients with ITP produce platelets that are recognized by the spleen as abnormal and destroyed prematurely. Once the number of platelets falls below a critical level the result is spontaneous skin bruising and bleeding that will not stop. The underlying cause of this condition remains unknown so there is no known cure. Medical treatments, such as steroids and Gamma Globulin can often stabilize the platelets temporarily, allowing them to escape destruction by the spleen.
Removal of the spleen often offers the best long-term solution to this potentially life-threatening condition.Prior to splenectomy the blood is tested to measure the number of platelets. If the platelet count is extremely low a transfusion of platelets may be required to raise the count enough to make it safe to proceed with the operation. After the operation it is important to monitor the platelet count closely to determine the response to splenectomy. It may take several days before the platelet count begins to rise.
In most cases laparoscopic surgery can be used to remove the spleen. The organ is carefully separated from its attachments and the large splenic blood vessels are divided using a vascular stapler. The spleen is then placed in a plastic bag and crushed into small fragments, allowing it to be removed from the abdomen through a very small incision. Most patients are able to leave the hospital within a day or two, and are typically able to return to normal activity, including light exercise, within two weeks. Heavy lifting and straining should be avoided for a few weeks to allow the incisions to heal completely.
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