Splenic injuries in adults: selective nonoperative management

Area of Science:

• Trauma Surgery
• Surgical Gastroenterology

Background:

• Nonoperative management is standard for pediatric splenic injuries but infrequently used in adults.
• Adult splenic trauma management often defaults to surgical intervention.

Purpose of the Study:

• To evaluate the efficacy and safety of nonoperative management for hemodynamically stable adults with isolated splenic trauma.

Main Methods:

• Retrospective review of 11 hemodynamically stable adult patients with isolated splenic trauma.
• Inclusion criteria: no other significant injuries, initial stability or response to fluids.
• Diagnostic imaging included liver-spleen scans and celiac arteriography.

Main Results:

• Eight of eleven patients were successfully managed nonoperatively.
• Three patients required laparotomy due to decreasing hemoglobin; one underwent partial splenectomy.
• Nonoperatively managed patients tolerated oral alimentation by day 2 and were discharged by day 12.

Conclusions:

• Nonoperative management is a viable and successful strategy for select adults with isolated splenic trauma.
• Careful patient selection and monitoring are crucial for successful nonoperative treatment.