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James R. Elmore, MD; David E. Clark, MD; Robert J. Isler, MD; William R. Homer, MD

Arch Surg. 1989;124(5):581-586.

Abstract
• 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.

(Arch Surg. 1989;124:581-586)

Author Affiliations
From the Departments of Surgery (Drs Elmore, Clark, and Horner) and Radiology (Dr Isler), Maine Medical Center, Portland.

Footnotes
Accepted for publication December 7, 1988.

Read before the 69th Annual Meeting of the New England Surgical Society, Montreal, Canada, September 17, 1988.

Reprint requests to Department of Surgery, Maine Medical Center, 22 Bramhall St, Portland, ME 04102 (Dr Elmore).

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