Nonoperative management of the adult ruptured spleen
M. R. Villalba, G. A. Howells, R. J. Lucas, J. L. Glover, P. J. Bendick, O. Tran and S. Z. Jafri
Department of Surgery, William Beaumont Hospital, Royal Oak, MI 48073.
The risk of postsplenectomy sepsis has led to increased enthusiasm for
preservation of the spleen. From January 1984 to December 1988, 51
consecutive adult patients with ruptured spleen sustained from blunt trauma
were examined. Thirty-four patients (67%) had their conditions
hemodynamically stabilized at the time of hospital admission and were
placed on a regimen of strict bed rest with intensive monitoring. The
average hemoglobin value at hospital admission in this group was 126 +/- 18
g/L, with an average drop of 17 +/- 14 g/L during their hospitalization; 14
patients required transfusions averaging 3 U each. Nonoperative treatment
was successful in 33 (97%) of 34 patients; one patient whose condition
deteriorated clinically underwent splenectomy on the fifth hospital day.
These patients have been followed up for an average of 28 months with no
sequelae from their splenic injury. We conclude that a nonoperative
approach is a viable alternative in stable adult patients with splenic
injuries due to blunt trauma when intensive monitoring is available.
