How to Care for Your Child at Home After a Splenectomy

A splenectomy is an operation to remove the spleen. The spleen is located in the left upper abdomen just under the rib cage and it plays a role in fighting infection and making red blood cells.

There are many reasons that a spleen may need to be removed, including infection, cysts, trauma, anemias, immune disease and cancer. How severely the spleen is affected by the disorder or injury determines if and when the spleen should be removed.

Surgery to remove the spleen may be done open or laparoscopically. In an open approach, an opening is made through the abdomen to remove the spleen. Laparoscopy involves a camera (scope) that is placed through the belly button to see the spleen while surgical tools to remove the spleen are inserted through small openings in the abdomen. Your child’s surgeon will determine which approach is appropriate for your child.

After surgery your child will go to the recovery room and then be transferred to the pediatric floor of the hospital. They will have an intravenous (IV) catheter--a small tube in their vein--through which your child will receive pain medication, antibiotics, and fluid. Some children will have a tube in their nose to drain fluid from their stomach; some children will have a tube in their bladder to drain urine. Your child will be closely monitored after the operation for any signs of bleeding or infection.

Your child will be able to go home from the hospital once they are able to eat and drink their regular diet, take pain medication by mouth, have no signs of bleeding or infection (fever) and is able to walk about.

Before or soon after surgery, it is recommended that your child receive the following vaccines to prevent infection:

• Pneumococcal Vaccine (Pneumovax), boosted every 5-6 years
• Haemophilus Influenza Type B (Hib) Vaccine
• Meningococcal Vaccine (Menomune®), boosted every 8-10 years
• Influenza (flu) vaccine is recommended yearly

Having blood levels drawn for the pneumococcal vaccine may be helpful in determining if an additional vaccine dose is required.

It is recommended that your child wear a medic alert bracelet stating that they have had a splenectomy. You may contact the Medical Alert Foundation® at www.medicalert.org or by telephone at (888) 633-4298. You may also be able to get one at your local pharmacy or medical supply store.

Your child will take antibiotics on a daily basis after surgery. It is important that the antibiotics be taken every day as prescribed to prevent any infections that the spleen would normally help to fight. If your child develops any signs of infection such as fever, chills, cough, muscle aches, headache, vomiting, diarrhea or abdominal pain, you may be instructed to give extra antibiotics and take your child to the hospital. Your child’s teachers and childcare providers should also know to look for these signs and report them immediately.

Splenectomy Discharge Instructions

Dressing

A white gauze dressing(s) covered by clear plastic (Tegaderm®) – This is usually removed 2 days after surgery. Beneath the gauze dressing(s) are small white bandages (Steri-strips®). These will usually fall off in 1-3 weeks.

Stitches<?h3>

• Stitches hold the incision together. They are under the skin and do not need to be removed, the body will absorb them.
• There are Steri-Strips covering the surgical wounds which will fall off on their own.

Activity

• Your child should participate in quiet activities for the first few days after surgery.
• Your child can usually return to school soon after the surgery if the procedure is done laparoscopically.
• Your surgeon will instruct you regarding how long your child will need to restrict their physical activities.
• If the operation is done as an open procedure, children can usually return to school in a week or so, depending upon how they feel. When your child returns to school, they should not carry more than the weight of two textbooks.

Diet

• Your child may eat or drink as usual when you are at home.
• If vomiting occurs, do not give your child anything to eat or drink for 2 hours. Then offer small amounts of clear liquids or half strength juice until your child does not vomit any more. Then slowly start on their normal diet. If your child continues to vomit, please call the office.
• While your child is taking pain medication, please increase their intake of water and fresh fruits and vegetables to counteract the constipating nature of the pain medicine. If your child is constipated, a laxative or stool softener may be recommended.

Pain

• Your child may have a prescription for pain medication such as oxycodone. If the incision(s) remain uncomfortable, use the prescription medication according to instructions.
• Your child may take Tylenol® (acetaminophen) or Motrin® (ibuprofen) for discomfort if the pain is mild.

Please call the office if your child develops any of the following:

• Fever > 100.5 F
• Redness, swelling, or drainage from the incision site
• Pain despite the prescription medication
• Shortness of breath
• Worsening pain, such as increased left shoulder or abdominal pain

If you have any questions, please call your surgeon’s office at 617-726-0270.

Rev. 12/2019. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed in this handout. This document is intended to provide health related information so that you may be better informed. It is not a substitute for a doctor's medical advice and should not be relied upon for treatment for specific medical conditions.