The management of blunt splenic trauma

Seventy cases of blunt splenic trauma were retrospectively reviewed for the period 1979-1984. There were 57 adults and 13 children. Motor vehicle accidents were implicated in 62%. Forty-five splenectomies and eight splenorrhaphies were performed. The patients fell into two groups. Group A, numbering 48 patients, were those operated upon within 24 hours of injury. The mortality rate was 16%, and no deaths were attributable to splenic injury. Indications for surgery were hemodynamic instability in 46% and positive peritoneal lavage in 40%. Group B included 22 patients, 17 of whom were managed nonoperatively with no deaths. Five patients eventually went to laparotomy. Fifty per cent of all patients had associated intra-abdominal injury but only 17% needed repair; 31% of patients were initially managed conservatively with a 77% success rate and no mortality. It is concluded that conservative management is safe in stable patients with blunt splenic trauma.