Table 3. Indications and contraindications for splenectomy.

HS: hereditary spherocytosis; TB: tuberculosis; ITP: idiopathic thrombocytopenic purpura

Absolute indications for splenectomy	Relative indications for splenectomy	Absolute contraindications for splenectomy	Relative contraindications for splenectomy (laparoscopic approach)
Splenic trauma, i.e., splenic rupture either spontaneous (tropical splenomegaly) or delayed (subcapsular hematoma)	Congenital or acquired hemolytic anemia	Uncorrectable coagulopathy	Active hemorrhage with hemodynamic instability
HS	Thalassemia	Severe cardiovascular disease making the patient unfit for general anesthesia	Non-platelet coagulopathy
Splenic abscess (TB infection)	Acute, chronic myeloid or chronic lymphatic leukemia	Cirrhosis with portal hypertension	Contraindications to pneumoperitoneum
Splenic cyst	Lymphoma (Hodgkin’s)		Splenomegaly
As part of radical surgical removal of locally advanced gastric carcinoma, pancreatic carcinoma	Polycythaemia vera and myelofibrosis		Pregnancy
Angioma	Acute or chronic ITP		Extensive previous upper abdominal surgery
Primary splenic malignancy (rare)	Parasitic infestation, malaria, and Felty’s syndrome
Aneurysm of splenic artery	Angioma, cysts, and metastases
Bleeding esophageal varices secondary to splenic vein thrombosis	Tropical or non-tropical splenomegaly
	Intrahepatic or extrahepatic portal hypertension
	Amyloidosis and Gaucher’s disease