Selective nonoperative management of blunt splenic trauma in adults
J. R. Elmore, D. E. Clark, R. J. Isler and W. R. Horner
Department of Surgery, Maine Medical Center, Portland 04102.
The use of selective nonoperative management of blunt splenic trauma in
adults is based on the undeniable benefits of this approach in children.
Proper patient selection requires hemodynamic stability, lack of
generalized peritoneal irritation, and minimal blood transfusion needs.
Computed tomography is now used to make the diagnosis, but the decision for
laparotomy is based on clinical grounds. Forty-one (87%) of 47 patients
selected for nonoperative management were treated successfully without
laparotomy, while the remaining 6 patients underwent delayed operations for
persistent splenic bleeding. Blood transfusion requirements were
significantly less in the observed group than in the operative group for
patients with isolated trauma and for patients with polytrauma. There were
no known missed intra-abdominal injuries and no deaths with the
nonoperative approach. Analysis of our results has confirmed that
nonoperative management is a safe and effective alternative to immediate
laparotomy in properly selected patients and it can result in splenic
salvage without the need for an operation.
