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Abstract
There is growing awareness that the majority of traumatic splenic injuries should
be managed non-operatively. This review of all traumatic spleen injuries at a large
community teaching hospital over a 10-year period (1978–1988) confirms that principle.
The study generated selection criteria and principles of non-operative management.
Of a total of 91 patients, 23 were initially treated non-operatively. The average
age was 27 years and all but two were adults. Splenic injury was confirmed by computed
tomography scan in 20 patients (87 per cent) and by liver/spleen scan in three patients
(13 per cent).
Of the 23 patients, 21 (91 per cent) were successfully treated non-operatively. Of
these, 14 had intraparenchymal or subcapsular haematomas and seven had splenic lacerations
with haemoperitoneum. Two patients (9 per cent) initially treated non-operatively
required splenectomy.
Haemodynamically stable adult patients with blunt splenic injuries can be managed
non-operatively if monitored in a setting where immediate operative intervention is
available. Operative intervention is indicated not only in haemodynamically unstable
patients, but also in patients who require more than four units of blood during a
48-h period.
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Article info
Publication history
Accepted:
December 11,
1990
Identification
Copyright
© 1991 Published by Elsevier Inc.