Spleen Location and Function
The spleen is a purple colored, fist-shaped organ that lies in the upper left quadrant of the abdomen, hidden beneath the lower part of the rib cage. It is approximately four inches in length and 150-200g (7oz) in weight, but the exact shape and size varies between individuals. The main purpose of this organ is to produce new blood cells and to remove old blood cells. It is a reservoir of cells that comprise the body’s immune system, and plays a key role in fighting infections.
Meaning of Spleen Pain
Spleen pain is usually felt in the upper left quadrant of the abdomen, at the lower part of the rib cage along the flank. However, this part of the abdomen is also the location of other organs like the kidney, stomach, and the colonic flexure. Therefore, pain in upper left region of the abdomen cannot immediately be ascribed to the spleen, until the involvement of the other organs in the same region has been ruled out.
Pain in this region could also be gastric pain, kidney pain, mid-back pain, or abdominal pain. Spasms in the colon or trapped gas can also give rise to pain in this region. Pain due to spleen is a serious matter, and can lead to lethal consequences if not treated promptly. Therefore, any unusual pain in the upper left quadrant of the abdomen is a cause for concern, and should be checked by your doctor.
Pain and Other Symptoms
Spleen pain is a symptom and may be accompanied by other symptoms.
- The main symptom is pain in the left upper quadrant of the abdomen, between the 9th and the 11th ribs of the rib cage. The pain is usually felt on the flank.
- The pain may also radiate to other regions, such as the left side of the chest, left shoulder, middle back region, and the umbilicus. Sometimes, the pain may even extend to the right side of the abdomen.
- A palpable/detectable spleen. The spleen is normally hidden inside the rib cage and is not palpable. In case of spleen pain due to enlargement of spleen, it may become palpable just below the left costal margin of the rib cage.
- Spleen pain aggravates when breathing in (inspiration phase) as the diaphragm flattens and pushes against the spleen. It is felt more sharply while taking deep breaths or during sneezing.
- Stomach distension due to a large meal may also aggravate spleen pain by putting pressure on it.
Read more on pain under left rib cage.
Causes of Spleen Pain
Spleen pain is mostly caused by an injury to the spleen. This may occur in various conditions such as:
- Splenic infarct: Infarction refers to the death of a tissue due to lack of blood supply to the spleen. It can happen when there is a blockage in the splenic artery or any of its branches that supply blood to the spleen. The most common cause of such a blockage is the presence of an embolus. The embolus could be a blood clot (called thrombus), fat, gas bubble, or any foreign material. When an embolus blocks the blood flow in the splenic artery or any of its branches, the part of the spleen supplied by it is starved of oxygen and dies.
- Rupture of the spleen: The spleen is covered by a tissue capsule which normally keeps the organ together and protects it from rupture, even if it grows in size. However, spleen rupture can happen in certain cases, leading to spleen pain. Trauma to the upper abdomen, either by blunt force (in case of a violent punch or accident) or by a sharp object (such as broken ribs penetrating the spleen, knife injury) could rupture the capsule and the spleen. In rare cases, a spontaneous rupture of the spleen may occur even in the absence of any trauma. This usually happens when the capsule is weak, and with certain infections and neoplasms.
- Splenomegaly: Splenomegaly refers to an enlargement of the spleen. Sometimes, the extent of enlargement makes the spleen palpable even about 3 inches below the costal margin. Despite the abnormal enlargement of the organ, splenomegaly rarely causes rupture of the spleen. Most cases of mild to moderate splenomegaly cause a sense of pressure and discomfort in the abdomen rather than obvious pain. There may be pain in case of excessively large splenomegaly, especially when it is caused by an infection. In such cases, pain is the result of inflammation caused by pro-inflammatory cytokines.
- Splenic abscess: Splenic abscess is a rare condition caused by infection of the spleen. It is caused by pathogenic microbes (bacteria and fungi) that mostly reach the spleen through the blood from some other infected part of the body. If left untreated, splenic abscess can be lethal.
- Splenic fistulas: Fistula refers to an abnormal connection between two hollow spaces or tissues. Splenic fistulas can be gastro-splenic, colonic-splenic, and perinephric-splenic. These are very rare cases.
Read more on left side abdominal pain.
Treatment for Spleen Pain
All the causes of spleen pain described above are serious and life-threatening. Therefore, prompt treatment of the underlying cause of spleen pain is essential. The exact treatment would depend on the diagnosis of the condition that is causing the spleen pain. A doctor will do a physical examination of the left upper quadrant of the abdomen, and may also prescribe further tests (such as ultrasound, CT scan, MRI, and biopsy) to accurately diagnose the cause of the spleen pain.
Some of the treatments that may be prescribed include:
- Surgery: Surgery is required to treat a severely ruptured spleen or in case of splenic fistulas.
- Rest: If the injury to the spleen is small, it may heal on its own in time. Strict bed-red with monitoring would be advised in this case. Sports and any other physical activities that could aggravate the spleen injury would be strictly prohibited since any blow could be lethal.
- Analgesics: Pain management could be done through analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and narcotics.
- Splenectomy: In some cases such as multiple splenic abscesses, removal of spleen (splenectomy) may be required. After removal of the spleen, the patient would be put on antibiotics and also receive immunizations to prevent infections.