From the Guidelines
Splenomegaly itself does not always cause pain, but it can cause discomfort or pain in some cases, particularly when the spleen enlarges significantly and stretches its capsule or presses against nearby organs, as noted in patients with chronic myeloid leukemia 1. When pain occurs, it's typically felt in the upper left abdomen and may radiate to the left shoulder. The pain is often described as a dull ache or feeling of fullness, especially after eating. Some patients with splenomegaly may experience left upper quadrant fullness or pain due to the enlarged spleen, as seen in 40%–50% of cases of chronic myeloid leukemia 1. Pain becomes more likely as the spleen enlarges significantly, and severe or sudden pain may indicate complications like splenic infarction or rupture, which require immediate medical attention. The reason splenomegaly doesn't always cause pain is that the spleen can gradually enlarge, allowing surrounding tissues to accommodate its increased size. However, physical activities that jostle an enlarged spleen, including contact sports, can trigger pain and increase the risk of rupture. Anyone diagnosed with splenomegaly should avoid such activities until cleared by their physician. Treatment focuses on addressing the underlying cause of the enlarged spleen rather than the splenomegaly itself, such as in the case of sickle cell disease where splenic sequestration may occur 1. Key considerations in managing splenomegaly include monitoring for signs of complications and adjusting treatment accordingly, as well as providing guidance on lifestyle modifications to reduce the risk of rupture or other adverse outcomes. In some cases, surgical splenectomy may be recommended to prevent recurrence of life-threatening or recurrent episodes, such as in patients with sickle cell disease 1.
From the Research
Splenomegaly and Pain
- Splenomegaly, or the enlargement of the spleen, can be caused by various underlying conditions, including liver disease, malignancy, and infection 2.
- The symptoms of splenomegaly can vary, but abdominal pain is a common complaint, particularly if the spleen is massively enlarged 3.
- In some cases, splenomegaly can cause pain due to the stretching of the spleen's capsule or the compression of surrounding organs 4.
- The diagnosis of splenomegaly typically involves physical examination, abdominal ultrasonography, and laboratory tests to determine the underlying cause 2, 5.
- Treatment of splenomegaly usually focuses on addressing the underlying condition, and in some cases, splenectomy (surgical removal of the spleen) may be necessary to relieve symptoms and prevent complications 3, 6.
Common Causes of Splenomegaly
- Liver disease, malignancy, and infection are among the most common causes of splenomegaly in the United States 2.
- Malaria and schistosomiasis are common causes of splenomegaly in tropical regions 2.
- Lymphoid malignancies, including splenic lymphoma, can also cause splenomegaly 5, 6.