Splenic conservation after multiple trauma in adults.

The traditional management of splenic injuries is undergoing serious challenge. During the four year period from 1980 to 1983, 60 of 230 patients with injured spleens operated upon at the Maryland Institute for Emergency Medical Services' Shock Trauma Center have had splenic salvage. Motor vehicle accidents accounted for 57 of the 60 injuries (95 per cent). Fifty-eight patients (97 per cent) had major associated extra-abdominal injuries (average 1.9 injuries per patient) requiring additional operative procedures. Concurrent intra-abdominal injury was present in 37 patients (62 per cent). The mean operating time was 106 minutes; 98 minutes for those patients with isolated splenic injuries and 115 minutes for those with associated minor intra-abdominal injuries. The average amount of blood transfused during celiotomy was 3.5 units of packed red blood cells per patient. As familiarity and confidence with the techniques have accrued, the number of splenic preservation procedures has steadily increased from approximately 10 per cent to more than 50 per cent. Complications related to splenorrhaphy per se were few. The mortality was 10 per cent; all deaths were secondary to associated injuries. Criteria for and contraindications to splenic salvage in patients with multiple trauma are presented and discussed.