Ruptured spleen in a malarious area: with emphasis on conservative management in both adults and children.

Sixty-two consecutive cases of ruptured spleen occurring in a malarious area and reviewed. Nineteen died before treatment could be commenced. all patients who survived the initial hypotensive episode, and who were admitted to our unit, recovered, whether managed operatively or nonoperatively. We have conserved 26 spleens and removed 17. One splenectomised patient is known to have died subsequently from cerebral malaria. Although four cases of delayed rupture were seen, no conservatively treated patient had a delayed haemorrhage. Our policy is to avoid removal of the spleen in malarious areas in both adults and children.