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Its Management in a Patient Population With a High Incidence of Associated Injury

Charles D. Livingston, MD; Kenneth R. Sirinek, MD, PhD; Barry A. Levine, MD; J. Bradley Aust, MD, PhD

Arch Surg. 1982;117(5):670-674.

Abstract
• Nonoperative management of splenic trauma is receiving increasing support following delineation of the spleen's role in infection. Controversy regarding the proper management of this injury led us to study retrospectively 236 consecutive patients with splenic trauma. Blunt trauma occurred in the majority (161); the remainder suffered penetrating abdominal injury secondary to gunshot or stab wounds. Diagnostic peritoneal lavage was accurate in establishing splenic injury in blunt trauma (no false-positive, but three false-negative findings). Associated intra-abdominal injury occurred in 48% and 92% of patients with blunt and penetrating trauma, respectively. Diagnostic peritoneal lavage is an accurate method for establishing an intraabdominal injury and the need for abdominal exploration in patients with blunt abdominal trauma. Because of the high rate of associated intra-abdominal injury in splenic trauma, nonoperative management can be expected to result in a disturbing incidence of missed intra-abdominal injury in patients with abnormal peritoneal lavage findings.

(Arch Surg 1982;117:670-674)

Author Affiliations
From the Department of Surgery, The University of Texas Health Science Center, San Antonio.

Footnotes
Accepted for publication Jan 7, 1982.

Read before the 89th annual meeting of the Western Surgical Association, Albuquerque, Nov 17, 1981.

Reprint requests to Department of Surgery, The University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78284 (Dr Sirinek).

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