Management of Injury to the Spleen in Adults Results of Early Operation and Observation

Abstract

Seventy-seven adults with spenic trauma were treated at a Level 1 Trauma Center during a 4-yr period. Patients (67) and early operation (55 splenectomy, 9 splenorrhaphy, 3 partial splenectomy). Ten adults with stable vital signs were initially managed by observation without operation. Patients who had other intra-abdominal injuries were more likely to have an early operation and splenectomy. Patients who had a lesser transfuion requirement were more likely to have initial nonoperative management. Only 3 of the 10 patients who were managed initially by observation avoided eventual operation. Six of the 7 patients who failed observation management required splenectomy. Patients with isolated splenic injuries had a significantly shorter hospital stay after an early operation than after observation without operation (P < 0.05). Early operation is recommended for the management of splenic injury in adults. Observation of isolated splenic injuries frequently is unsuccessful in adults and unnecessarily prolongs hospital stay.