Spleen pain is difficult to identify due to its close proximity to other abdominal structures like the stomach, left kidney, left colonic flexure and abdominal wall. Pain in the left upper abdomen or back may be related to these surrounding organs and not due to the spleen itself.
The most notable features of spleen pain is that it is :
- Aggravated during breathing (usually inspiration) and more prominent upon deep breaths and sneezing
- Exacerbated by large meals as a result of a distended stomach
Location of Spleen Pain
The spleen lies at the level of the 9th to 11th ribs which means that it is tucked under the left ribcage. It is located just posterior (behind) the mid-axillary line (refer to picture below) lying in close proximity to the posterolateral abdominal wall. Under normal circumstances, when the spleen is not enlarged, it cannot be palpated. Spleen pain may radiate to the shoulder, mid back, umbilicus, left side of the chest and less frequently to the right side of the abdomen.
When enlarged and extending below the costal margin, the spleen can be palpated on the anterolateral aspect of the abdomen and the superficially lying notched border makes it clearly discernible. However, as mentioned below under the causes of spleen pain, mild to moderate splenomegaly (enlarged spleen) rarely causes spleen pain. Tenderness and discomfort may be noted upon palpation or after eating due to the distended stomach. In massive splenomegaly, the spleen may be palpable up to 8 centimeters (about 3 inches) below the costal margin and extends medially towards the umbilicus (belly button).
Pain on the side of the left upper quadrant of the abdomen should not be immediately attributed to the spleen. A number of other causes of pain in this area are discussed in the articles below and should be investigated and excluded before diagnosing spleen pain.
- Gastric Pain (Stomach)
- Kidney Pain Location (also refer to Causes of Kidney Pain)
- Left Upper Abdominal Pain
- Mid Back Pain
Splenic flexure syndrome is pain in and around the left colic flexure possibly as a result of colonic muscle spasms or trapped gas. In the event of constipation or gas trapped at this site, a firm mass may be palpable in the upper left abdominal area. This may sometimes be visible and feel like a hard knot or ball and is not due to enlargement of the spleen (splenomegaly).
Causes of Spleen Pain
The two likely causes of spleen pain is an infarct or rupture of the spleen. Both conditions are considered as medical emergencies and could be fatal if immediate medical attention is not sought. Although splenomegaly (enlarged spleen) is thought of as a common cause of spleen pain, it rarely causes pain but rather discomfort and mild tenderness.
Splenomegaly (Enlarged Spleen)
Splenomegaly usually does not cause spleen pain. There may be some pain in the case of a massive splenomegaly or in cases of infectious and inflammatory causes of splenomegaly where proinflammatory cytokines may cause painful splenitis.
Usually splenomegaly causes a dragging or dull rubbing sensation, especially when the stomach is distended after eating, but this is more a feeling of pressure than actual pain. The spleen has an elastic capsule and is capable of expanding several times its normal size without rupturing. Therefore mild to moderate splenomegaly should not elicit notable pain.
A splenic infarct is death of splenic tissue as a consequence of a blockage in the splenic artery or its branches. Due to the obstruction, oxygen-rich blood cannot reach certain areas of the spleen and this results in ischemia (tissue injury due to hypoxia) and eventually an infarct. The most common cause of an arterial blockage leading to a splenic infarct is due to an embolus.
Trauma to the upper abdominal area may cause a rupture of the spleen. This can be due to sharp force where overt signs of penetration and gross hemorrhaging will be clearly evident. Blunt force trauma can also lead to a spleen rupture often related to a fracture of a rib and penetration of the spleen.
Rarely, a spontaneous rupture may occur with little or no blunt trauma force. In these cases, there is usually an abnormality of the spleen causing a weakening of the splenic capsule as is seen with certain infections and neoplastic conditions. Splenomegaly itself, even massive splenomegaly, rarely results in a rupture.
Other Causes of Spleen Pain
- Splenic abscess
- Splenic fistulas