An enlarged spleen in children is an increase in the size of the spleen inside the abdomen as a result of many diseases, the most important of which are blood diseases that cause a feeling of fullness and discomfort in the place of the spleen in the child’s body.
An enlarged spleen in children is a common complaint at this age, as it can be associated with blood diseases, particularly liver diseases. Still, not every enlarged spleen reflects a pathological condition.
What is an enlarged spleen in children?
The spleen in the human body is an organ located in the left upper quadrant of the abdomen below the rib cage, Its size increases with age, but it often cannot be felt naturally except in some instances, such as a thin and premature baby born before the expected due date (before the 37th week of pregnancy).
The Swelling of the spleen in children Or palpation of a mass in its place that we call an enlarged spleen in a child, and some may call it that Spleen disease in children It is the most common disease that affects the spleen, and it is a pathological condition requiring rapid intervention by doctors to find out the cause of the enlarged spleen and how to treat it if specific symptoms appear in the child.
Symptoms of an enlarged spleen in children
Most cases of spleen enlargement in children are asymptomatic and detected by chance during a routine clinical examination of the child. Still, he can present with one of the following symptoms and signs:
- The belly has increased.
- Jaundice (yellowing of the skin).
- Spleen pain and crying of the child, especially upon palpation (touch) during the clinical examination.
- In the case of severe enlargement of the spleen in children, it can put pressure on the spleen's blood vessels, which affects its blood supply and, thus, a defect in blood filtering. It can also pressure the stomach and cause symptoms and pain – especially after eating.
- Anemia leads to pallor because the enlarged spleen removes red blood cells to a large extent and does not produce enough white blood cells, which negatively affects the body’s immunity, causing infections and diseases to multiply.
Causes of enlarged spleen in children
Many causes or diseases lead to an enlarged spleen in children, some of which cause temporary enlargement of the spleen that can be treated, and some that cause permanent gain. The most important causes of an enlarged spleen in children are:
Infectious causes
The most common infectious causes that can cause an enlarged spleen in children are bacterial infections that can lead to inflammation of the spleen in children and then enlarge it. The most prominent of these germs are:
- Salmonella typhi and paratyphi
- Rickettsia, which causes typhus
- Syphilis
- Tuberculosis; It can cause an enlarged spleen in immunocompromised children and those with other diseases
In some cases, after a bacterial infection, an abscess of the spleen may form, which causes enlargement of the spleen in children, causing compressive symptoms in the abdomen. Also, sepsis can occur, a severe condition requiring immediate treatment.
Among the viral causes, we mention infectious mononucleosis and immunodeficiency virus associated with thrombocytopenia, in addition to protozoa and parasites such as schistosomes, trypanosomes, malaria and also the Echinococcus granulosum parasite that causes the hydrocyst.
Bloody causes
Many blood diseases cause an enlarged spleen in children, but the spleen doesn't need to be palpated during a clinical examination. The most prominent of these diseases are:
- Acute leukemia
- Chronic leukemia
- Thalassemia
- Idiopathic thrombocytopenic purpura
- Autoimmune hemolytic anemia
- Inherited spherocytosis
- Sickle cell anemia
- Iron deficiency anemia
metabolic causes
- Rickets; The most important metabolic disease that can cause an enlarged spleen in children
- Amyloidosis
- Gaucher disease
- Niemann-Pick disease
circulation causes
Any obstruction and increased tension within the portal vein in the context of other diseases can cause enlargement of the spleen in children. Hypertension of the portal segmental vein can occur in the event of thrombus formation in the splenic vein or the occasion of the construction of cancer in the pancreas.
neoplastic causes
An enlarged spleen in children may occur in many hematomas, the most important of which are:
- Lymphoma (especially Hodgkin lymphoma)
- Hemangioma
- Primary fibroma
- Myelofibrosis (an uncommon type of bone marrow cancer)
other causes
- Still's disease (systemic idiopathic arthritis in children)
- Non-parasitic splenic cysts
Diagnosing an enlarged spleen in children
Diagnosing an enlarged spleen in children depends mainly on palpation of the left upper quadrant of the abdomen during the clinical examination of the child. The spleen can be palpated in infants and young children usually, but palpation of the spleen in older children is often considered pathological.
Sometimes several laboratory tests can be used to confirm the diagnosis of an enlarged spleen, such as a complete blood count showing the number of white and red blood cells and platelets. We can also request an analysis of liver enzymes if we suspect that the cause of an enlarged spleen is liver disease.
In some cases, we resort to radiological methods to determine the size of the enlarged spleen in children and its relationship to neighboring organs. The most prominent of these methods are:
- Ultrasound imaging (echo): It is distinguished by its speed compared to other imaging methods.
An enlarged spleen in a child on ultrasound - Computed tomography (CT): through which the size of the spleen and its relationship with neighboring organs can be accurately known.
An enlarged spleen in a child on an abdominal CT scan - Magnetic resonance imaging (MRI): It can track the movement of blood flow through the organ of interest.
To find out the underlying cause An enlarged spleen for children We can resort to examining a solid biopsy of the bone marrow, aspiration of a liquid sample from it, or even both, as both models are taken from the hip bone under local or general anesthesia.
A biopsy of the spleen by needle has become rare due to the high rate of bleeding during this procedure. Sometimes, if it is not possible to know the causes of the enlarged spleen, the doctor may recommend removing the spleen as a diagnostic measure to find out the actual cause of the enlargement.
Complications of an enlarged spleen in Children
An enlarged spleen in children, in the event of neglect and untreated, can lead to negative and life-threatening consequences for the patient. The most important complications that may occur are:
- Frequent infection
- Anemia
- Frequent bleeding
- Spleen rupture (patients with an enlarged spleen are more likely to rupture)
Treatment of enlarged spleen in Children
The treatment of an enlarged spleen in children with splenomegaly varies according to the cause of their enlarged spleen, but we often have to perform a surgical procedure in which we remove the spleen from the abdomen, or what is called Splenectomy operation , which is now widely performed in Türkiye.
If the cause of the spleen swelling in children is a bacterial infection, it is sufficient to give antibiotics. As for blood diseases such as thalassemia and sickle cell anemia, blood transfusion is vital in treating the disease.
Surgical treatment remains the best treatment for an enlarged spleen in the presence of tumors and cancerous masses, as in most cases, we have to remove it altogether to control the symptoms caused by the spleen tumor.
In the end, we must know that in the absence of symptoms associated with an enlarged spleen in children, such as pain in the spleen or symptoms that affect the average growth of the child, then it is sufficient for periodic monitoring every 6-12 months in the treatment of enlarged spleen, and that depends on the condition of the child and the cause of his enlarged spleen. As for severe inflation, it often requires a splenectomy in Turkey.
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