Changing trends in the diagnosis and management of rupture of the spleen.

In this series of 80 consecutive patients with injured spleens scintigraphy was the diagnostic mainstay and was performed in 63 patients. Fifty-five patients were initially managed without operation. Two of them, however, underwent laparotomy respectively 1 and 2 days after admission because of increasing symptoms and signs. Twenty-seven patients underwent laparotomy, with successful conservative surgery in 8 and splenectomy in 19. However, in at least five of these it was thought in retrospect that repair of the spleen might have been possible. There were no deaths or serious morbidity from the injury to the spleen. It is concluded that no operation or operative repair of the spleen is the treatment of choice in the majority of patients with blunt injuries. In order to avoid loss of life as well as loss of the spleen, strict adherence to an aggressive, exact diagnostic process, using non-invasive diagnostic imaging and close clinical observation, as well as experienced, painstaking surgical techniques, is necessary.