Clinical Presentation

Patients may be symptomatic either as a result of splenic enlargement or the underlying disease causing it.

• pain in the left upper quadrant of abdomen. Rupture of the spleen may be painless and yet cause intra-abdominal haemorrhage, shock and death. Severe pain due to infarction is common in children with sickle cell disease or adults with CML.

• early satiety or a feeling of fullness.

A palpable spleen is a major physical sign and may be due to hyperfunction, passive congestion or infiltration by infectious disease, benign and malignant haematological disorders, metastatic carcinoma (rare) and storage diseases (Table 44.5). Rarely, the cause is unknown.

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