Nonoperative Management of Blunt Splenic Trauma

Abstract

Splenic salvage procedures has become the primary and standard procedure for children having splenic injuries, but it is still controversial for adults. Between 1992-1994, 38 pediatric patients having splenic injuries were treated in Dr.M. Ü. Emergency Aid and Traumatology Hospital. Splenic injuries were defined by diagnostic peritoneal lavage, abdominal ultrasonography, computerized tomography and laparotomy. Conservative treatment was the therapeutical approach for 25 (65.7%,) patients. 13 patients (34.3%) who were hemodynamically instable and having concomitant' intraabdominal organ injuries were treated surgically. Of these 13 patients who were treated surgically, splenectomy was performed on 8, splenorrhaphy on 1. In 4 of these 13, no active bleeding from the spleen was observed during the operation, concomitantly injured abdominal organs were managed. Delayed splenectomies were performed on 2 patients who were initially stable. Operative management ration for adults having blunt abdominal injuries was 95% during the same period. We believe that the first decision for pediatric patients having splenic injuries is conservative approach.