Nonoperative management of splenic trauma. Conservative or radical treatment?

In a four-year experience with selective nonoperative management of splenic trauma in adults and children, 24 (35%) of 68 patients with documented splenic trauma were initially treated nonoperatively. In only one patient was an operation and laparotomy ultimately required. There was no morbidity or mortality in the nonoperative group. In the operative group (44 patients), 4% died after operation, largely of multiple injuries. Confirmation of splenic injury and follow-up of patients were mostly performed by splenic scintiscans. There was no significant difference in length of hospitalization between operative and nonoperative groups. Operative splenic repair and preservation of the spleen to prevent postsplenectomy sepsis often requires considerable experience and may be a lengthy, tedious procedure. Nonoperative therapy in adults and children is an attractive alternative in a selective group of patients.