What is the primary concerning complication of a splenectomy?

The primary concerning complication of a splenectomy is the increased risk of infections. The spleen plays a critical role in the immune response, particularly in filtering pathogens from the blood and producing antibodies to combat infections. When the spleen is removed, patients can no longer efficiently clear certain encapsulated bacteria, which are a common cause of severe infections.

This risk is particularly pronounced in children and can lead to serious complications such as sepsis and overwhelming post-splenectomy infections (OPSI), which can be life-threatening. Vaccination against encapsulated organisms (such as Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis) and prophylactic antibiotics are often recommended following splenectomy to mitigate this risk.

Other potential complications like post-operative bleeding may occur but are typically not as significant a concern in the long-term as the risk of infections. Long-term liver damage and pneumothorax are not directly related complications that arise from splenectomy, making them less relevant in this context.