Nonoperative management of solid abdominal visceral injury: Part I. Spleen

The relatively recent recognition of the immunological consequences of splenectomy in both children and adults, coupled with an increased use of noninvasive methods of detecting splenic injuries, has resulted in the development of a nonoperative approach to selected patients with blunt splenic trauma. Currently, nonoperative management of pediatric splenic injuries is the treatment of choice, with success rates greater than 90%. Due to the increased severity of injury in adult trauma patients, this method of treatment is applicable in only 50% of older patients with mild to moderate splenic trauma. As experience with nonoperative treatment has accumulated, the need for large blood transfusions, missed intestinal injuries, and delayed splenic rupture have been found to be uncommon events. However, patients selected for nonoperative management must be monitored in a setting where the treating surgeon is readily available for both serial examinations and operative intervention should nonoperative management fail.