[Spleen trauma]

The spleen is the intraabdominal organ the most often injured in case of blunt abdominal trauma. Cases of fulminant infection after splenectomy, both in children and in adults, point to the importance of developing a conservative approach to spleen trauma: abstention from surgery, conservative surgery. Total splenectomy does have its indications resulting either from the general condition of the injured patient, or peroperative observations. Approximately 30% of patients operated for spleen trauma undergo total splenectomy. Over the last 10 years, the proportion of conservative surgery cases has declined as abstention is increasingly favored, being adopted in 50 to 70% of cases with a success rate of at least 90%. Currently two initial criteria and one evolution criteria guide the decision to abstain from surgery: hemodynamic stability and absence of another intraabdominal lesion requiring laparotomy; and limit number of packed red cell units transfused. The decision to abstain from surgery implies very rigorous clinical monitoring. Imaging protocols vary. Computed tomography signs predictive of recurrent bleeding and the development of arteriography techniques with embolization may further raise the rate of success after abstention from surgery.