Splenic trauma: a trial at selective management.

The experience with splenic trauma at the Metropolitan Nashville General Hospital and at Vanderbilt University Hospital between 1972 and 1983 is the subject of this report. Of 154 emergency cases involving splenic injury, 134 were due to blunt trauma, with 20 cases resulting from penetrating injury. In 124 patients, exploratory laparotomy was done immediately after resuscitation and evaluation. Splenectomy was done in 113 (92%) cases, and in ten cases the spleen was repaired. Thirty patients (19.4%) were initially managed by observation of vital signs, serial hematocrit determinations, and serial physical examination. Of these 30 patients, 21 (70%) required exploratory laparotomy for continued bleeding after observation of 12 hours to six days. Eighteen of this group had splenectomy, and three had splenorrhaphy. Nine (5.8% of the total and 30% of the observed group) were successfully managed nonoperatively. Complications were encountered in 53 of the total 154 cases. There were 19 deaths (12.3%), 11 of them from head injuries. Splenectomy should be done promptly in cases of concomitant splenic and cerebral injury and in patients with injury of multiple organ systems. Nonoperative management of suspected splenic injury should be reserved for patients in stable condition and with few if any associated injuries.