The body’s lymphatic system fights off infections and maintains the balance of fluids, and the spleen is its largest organ. About the size of an adult’s fist and purple, the spleen is located just under the rib cage, in the upper left part of the abdomen. The spleen controls both white and red blood cell levels. Not only does this organ help protect the body against germs and infections, but it also regulates red platelet counts that allow clotting. Spleen pain can be an indication of a variety of issues.

The Helpful, But Not Essential Spleen

Around 740 pints of blood flow through the adult spleen every day. Because a human can live without a spleen, the medical community once believed that the spleen was an unnecessary organ. That opinion has changed, however. The spleen produces red blood cells in early life. Even though the bone marrow takes over that role as the body ages, the spleen continues to help fight off infection. Any pain in the left rib area or upper abdominal area could be a sign of infection or another condition affecting the spleen.

Spleen Ruptures

A rupture occurs when a traumatic blow causes a break or tear in the surface of the spleen. In most cases, the tear results from a forceful blow, such as the impact of a car crash. A spleen rupture is considered a medical emergency and sometimes requires surgery and a hospital stay. Without treatment, the person could bleed internally, leading to shock and other life-threatening complications. Pain behind the left ribs or in the left shoulder are signs of a rupture. Some individuals also experience confusion, dizziness, fainting, and blurred vision.

Spontaneous Spleen Ruptures

Although most spleen ruptures occur as the result of blunt force, spontaneous spleen ruptures are also possible. Infections or illnesses such as pneumonia, mononucleosis, and pulmonary infections may cause this type of rupture. Spontaneous ruptures also occur as a result of abnormal benign or malignant growths called neoplasias. Sudden onset of severe pain in the abdomen and left shoulder, especially from those already fighting off an infection, could indicate a spontaneous spleen rupture.

Enlarged Spleen (Splenomegaly)

Both infections and injuries cause an enlarged spleen, and there may be no warning symptoms. As the spleen increases in size, the risk of a spleen rupture also increases. Sharp pain in the left side could indicate the spleen is enlarged and pressing against the stomach, especially if the person also experiences nausea or unexplained weight loss. Enlarged spleens are a symptom of various illnesses including chronic or slow-growing leukemia, anemia, Hodgkin’s disease, mononucleosis, malaria, and juvenile idiopathic arthritis.

Hypersplenism

In some cases, the spleen may perform its filtering job too well, removing blood cells too early. Hypersplenism is common and can occur anytime there is an issue with the spleen. If the spleen filters out too many red blood cells, anemia develops. Too few white blood cells in the body make it vulnerable to infection. Because the spleen also produces red platelets, disruption can reduce blood clotting capabilities. There may be few or no symptoms of hypersplenism, but a feeling of fullness or discomfort in the left chest area or upper left abdomen could indicate a problem. If the issue goes untreated, pain may set in.

Splenic Abscess

Sudden pain in the upper left quadrant — the left side of the chest and upper abdomen — may indicate a splenic abscess. A fever, along with an inability to eat a full meal, are additional signs. In about half of the cases, these conditions relate to an enlarged spleen. However, the presence of bacteria, fungi, or yeasts in the blood can also cause an abscess to form on the spleen. Sometimes, the infection may start in a different organ and spread to the spleen. Spleen abnormalities may also cause abscesses, though this is rare.

Gaucher’s Disease

When abnormal chemical reactions interfere with the body’s process of creating energy from the food we eat, people develop metabolic disorders. A buildup of fatty substances in the spleen or liver causes these organs to enlarge and function less effectively. A genetic disorder, Gaucher’s disease primarily affects those of Ashkenaz Jewish descent. There are different types of the disease, but most result in enlarged spleens and livers, which become extremely distended and cause pain.

Other Causes of Spleen Pain

Certain prescription drugs may cause damage and spleen pain. All drugs have potential adverse effects, and some can be toxic to certain organs, interfering with their natural processes. Some can cause hemolysis in the spleen, which is a rupturing of red blood cells. However, once the individual stops taking the medication, the spleen pain usually goes away. Liver diseases, such as cirrhosis, can cause spleen pain as well. Cirrhosis of the liver also increases the blood pressure inside the spleen’s vessels, causing it to become enlarged, which leads to pain.

Diagnosis of Spleen Pain

An enlarged spleen can irritate the diaphragm, which causes hiccups. Pain may radiate to the back and shoulder blade. There is compression to the stomach, causing indigestion, discomfort, or a feeling of fullness after eating even a small amount of food. The doctor will review symptoms and perform a physical exam; palpitation cannot identify a normal spleen, but in most cases, the doctor can feel an enlarged one. Ultrasounds, abdominal CTs, x-rays, and MRIs can diagnose spleen issues and pain.

Treatment of Spleen Conditions

Rib fractures, pelvic fractures, and spinal cord injuries can occur as a result of blunt trauma to the abdomen. These types of injuries indicate a possibility of a spleen rupture as well. If there is internal bleeding, the patient may require removal of the spleen — a splenectomy. In less severe ruptures, a surgeon will repair the tear through splenic embolization, to stop the bleeding. In recent years, however, doctors have been able to avoid surgery in 95 percent of children’s cases and 60 percent of adult cases. Instead, doctors treat the rupture in stable patients with observation and blood transfusions.