Splenomegaly
Enlargement of the spleen due to infections, liver disease, or blood disorders.
Overview
Splenomegaly (enlarged spleen) is not a disease but a sign of an underlying condition. Common causes in India include malaria, portal hypertension (cirrhosis), hemolytic anemias, and hematological malignancies. Treatment targets the underlying cause; splenectomy is reserved for specific indications.
Causes
- Portal hypertension (cirrhosis)
- Infections (malaria, kala-azar, TB, EBV)
- Hemolytic anemias (thalassemia, spherocytosis)
- Hematological malignancies (lymphoma, leukemia, myelofibrosis)
- Storage diseases (Gaucher's)
- ITP (immune thrombocytopenic purpura)
Risk Factors
- Chronic liver disease
- Endemic infections (malaria regions)
- Hemoglobinopathies
- Autoimmune conditions
Symptoms
Diagnosis
- Physical examination (palpable below left costal margin)
- Ultrasound (measurement)
- CT scan (for cause)
- Blood tests (CBC, peripheral smear, LFTs)
- Bone marrow biopsy (if hematological cause suspected)
Treatment Options
Surgical Treatment
Splenectomy is indicated for: symptomatic massive splenomegaly, refractory ITP, hereditary spherocytosis, hypersplenism with significant cytopenias, or splenic vein thrombosis. Laparoscopic splenectomy is preferred when spleen size allows. Vaccination protocol essential pre-operatively.
Recovery
Laparoscopic splenectomy: 2-4 days hospital stay. Open (massive spleen): 5-7 days. Vaccination at least 2 weeks before elective splenectomy. Lifelong penicillin prophylaxis in children.
Prevention
- Prevent/treat malaria in endemic areas
- Hepatitis B vaccination (prevent cirrhosis)
- Avoid alcohol excess
- Regular monitoring of known hemolytic anemias
Frequently Asked Questions
Does an enlarged spleen always need surgery?
Is splenectomy safe?
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