The Unexpected Invitation to Chaos
No one ever schedules a splenectomy. It’s never on the calendar, never part of the plan.
It happens when a car goes sideways at high speed, or a rib fractures just the wrong way, or someone takes a hit in a rugby match that turns into a nightmare.
One minute you’re sipping lukewarm coffee, the next you’re elbow-deep in the upper left quadrant, chasing blood you can’t quite see the end of.
The spleen, in all its fragile glory, has a flair for the dramatic. It doesn’t just bleed, it performs. It makes sure you remember who’s in charge.
When the Spleen Decides to Misbehave
The first trap? Thinking it’s “just a little tear.”
You open up, and before you know it, the field is red, suction’s howling, and your heart rate’s keeping pace with the patient’s.
What started as a tidy plan for splenic preservation quickly becomes a grim game of damage control.
The spleen is soft, friable, and utterly unforgiving. One misplaced retractor, one overconfident tug, and you’re suddenly dealing with an organ that’s bleeding from every imaginable angle.
You pack, compress, stitch, and still, it seeps. Relentlessly.
Preserve or Remove: The Eternal Dilemma
Every trauma surgeon has faced that silent stare from across the table, the unspoken question: Do we try to save it, or take it out?
There’s always a twinge of guilt in going for splenectomy. You know the patient’s losing a piece of their immune defence forever. But sometimes the decision’s made for you.
The injury’s too deep, the oozing won’t stop, and you realise you’re fighting nature’s own sponge.
In those moments, pragmatism beats idealism. You sigh, reach for the vascular stapler or clamp, and move on. But it never feels good.
The Hilum: A Surgeon’s Bermuda Triangle
If there’s a single spot that’s broken more surgeons’ confidence than any other, it’s the splenic hilum.
Tucked close to the pancreas and the tail of the splenic vein, it’s a deceptively dangerous patch of anatomy.
You think you’re controlling one vessel, next thing you know, the pancreatic tail’s leaking or the splenic vein’s sheared off, and you’re in the middle of a slow-motion disaster.
I’ve seen bright young surgeons go pale when that happens. It’s not the amount of blood, it’s the realisation that one small misstep just turned a manageable injury into a minefield.
The rule? Respect the hilum. Always. Move with patience, not pride.
The Pancreas: Collateral Damage
The pancreas never wanted any part of this operation. It sits there, quiet and dignified, until your dissection gets a little too ambitious.
Suddenly, there’s a small ooze, then a trickle, and then, weeks later, a high-amylase drain output that just won’t stop.
It’s almost comical, how often we injure it without meaning to. You tell yourself you’ll be more careful next time. Then another trauma rolls in, and history repeats itself.
If there’s one truth about the spleen-pancreas neighbourhood, it’s this: it’s unforgiving, but fair. Rush it, and it’ll remind you. Gently at first, then emphatically.
The Sneaky Accessory Spleen: When You Think You’re Done
There’s a cruel kind of humour in realising months later that your “complete” splenectomy wasn’t so complete.
Persistent cytopenias, elevated reticulocyte counts, and there it is on imaging: a little splenule sitting smugly in the omentum or the hilum.
The spleen’s parting gift.
A leftover piece, still doing its job, mocking your “definitive” surgery from the shadows.
You can’t even be mad, really. The organ wins again.
Post-Splenectomy Fallout: The Real Battle
You close the abdomen, mop your brow, and think you’re done. But the spleen’s influence lingers long after it’s gone.
The post-splenectomy sepsis risk is no joke. OPSI (Overwhelming Post-Splenectomy Infection) hits fast, often fatally.
Pneumococcus, meningococcus, Haemophilus, it’s a rogues’ gallery of microscopic assassins waiting for their moment.
Vaccinations help, yes. Antibiotic prophylaxis too. But vigilance, lifelong vigilance, is what truly saves them.
You tell every patient: “If you get a fever, any fever, see a doctor. Don’t wait.” And you mean it. Because you’ve seen what happens when they don’t.
Then there’s thrombosis, the other uninvited guest. Post-splenectomy thrombocytosis can tip into portal or splenic vein thrombosis if you’re not watching.
A small clot becomes a big problem, and by the time it’s symptomatic, you’re back in crisis mode.
Lesson learned (and relearned): the operation ends, but the responsibility doesn’t.
Emotional Fallout: The Quiet Weight
There’s something quietly tragic about removing an organ that didn’t ask for trouble.
The spleen’s not malignant, not misbehaving by choice, it’s just in the wrong place at the wrong time.
I’ve stood over that open cavity more times than I can count, thinking, this feels like surrender.
But trauma doesn’t wait for poetry. Sometimes you remove the spleen not because you want to, but because you have to. And that’s enough.
Still, every time I close the fascia, there’s a small ache in the back of my mind, a whisper that says, remember what you took.
The Final Lesson
If the liver humbles you with its complexity, the spleen humbles you with its fragility.
It’s an organ that demands finesse, not force; patience, not bravado.
Every splenectomy teaches something new, usually the hard way. About anatomy. About judgment. About restraint.
And every so often, when the field finally clears, the bleeding stops, and the monitor steadies, you exhale, step back, and silently thank the spleen for the lesson.
Because in trauma surgery, as in life, the spleen always gets the last word.
And somewhere beyond the bright lights and sterile drapes, there’s the person you just saved.
They’ll wake up sore and dazed, not knowing how close they came, not realizing how many hands fought for their pulse. To them, the scar will be a reminder of a crash, a fall, a moment to you, just another case.
But for them, it’s everything.
Their story didn’t end on that table; it paused there, waiting for you to give it back.
Never forget, what feels like another night on call to us is the day their life began again.
