Minor splenic injuries: associated injuries and transfusion requirements

To address criticisms of nonoperative management of splenic injury, we hypothesized that (1) patients with minor splenic injuries have a lower risk of associated visceral damage than patients with splenic injuries in general, and (2) exploration of these patients does not decrease their blood requirements. We reviewed charts of 182 patients who suffered blunt splenic trauma between 1983 and 1988. Sixty-seven sustained minor injuries, defined as requiring no therapy or responding to topical hemostatic agents. Twenty-three were initially managed nonoperatively, with three subsequently explored surgically for falling hematocrit; no associated injury requiring therapy was found. The median transfusion requirement in these 23 patients was 2 units. Forty-four were immediately explored, 11 for readily diagnosed injuries mandating laparotomy. The other 33 were explored for hemoperitoneum. One had an unsuspected bowel injury. The median blood requirement in these 33 was 2.5 units. We conclude that patients with minor splenic injuries who have no other indication for laparotomy have a very low incidence of associated significant abdominal injury. Their transfusion requirements are also not reduced by exploration.