Management of injury to the spleen in adults. Results of early operation and observation.

Seventy-seven adults with splenic trauma were treated at a Level I Trauma Center during a 4-year period. Sixty-seven patients had early operation (55 splenectomy, nine splenorrhaphy, three partial splenectomy). Ten adults with stable vital signs were initially managed by observation without operation. Patients who had other intra-abdominal injuries were more likely to have an early operation and splenectomy. Patients who had a lesser transfusion requirement were more likely to have initial nonoperative management. Only three of the 10 patients who were managed initially by observation avoided eventual operation. Six of the seven patients who failed observation management required splenectomy. Patients with isolated splenic injuries had a significantly shorter hospital stay after an early operation than after observation without operation (p less than 0.05). We recommend early operation for the management of splenic injury in adults. Observation of isolated splenic injuries frequently is unsuccessful in adults and unnecessarily prolongs hospital stay.