Nonoperative management of injuries of the spleen in adults.

Seventeen adult patients with proved splenic injuries were managed nonoperatively without a single instance of morbidity or mortality. All patients had a clinical history and physical findings suggestive of splenic trauma; the diagnosis was confirmed by splenic scintigraphy and, in some patients, additionally by angiography. The selection of patients for nonoperative management was made on the basis of a stable clinical status and laboratory evidence of cessation of bleeding. Patients who had progressive hypovolemia, worsening abdominal signs and laboratory evidence of continued bleeding were subjected to laparotomy for the performance of total splenectomy, partial splenectomy or splenorrhaphy. An arbitrary limit of three transfusions was set beyond which laparotomy was mandated. Nonoperative management is clearly not indicated for all patients with splenic injuries. In selected patients, however, nonoperative management is feasible and safe, providing careful clinical and laboratory observations are available. The theoretical long term sequelae of splenosis and splenic cyst formation have not yet been observed.