Experience with the management of splenic injuries.

This paper reviews the experience of treating 128 patients with splenic trauma over a 10 year period. All patients were aged under 16 years and all except one had sustained non-penetrating abdominal injuries. The diagnosis was established at operation or by spleen scan or by angiography but the decision to operate was made on clinical grounds. Patients who were stable on admission or after initial resuscitation were managed expectantly. In patients requiring surgery for massive bleeding or for other injuries the spleen was repaired whenever possible. Only 29% of patients required operation and in three quarters of these patients the spleen was able to be preserved. Delayed rupture of the spleen did not occur in the non-operative group and septic complications have not been observed in any survivors. There were 14 deaths in the series, 11 from severe head injury and three from massive haemorrhage.