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The role of nonoperative management of the injured spleen.

The role of selective nonoperative management of blunt splenic injuries in adults has been the focus of considerable controversy over the last decade. This article reviews the markedly contrasting experiences of proponents and opponents of this approach. When strict selection criteria are applied (ie, hemodynamic stability, opportunity for close observation, and radiographic confirmation of severity of injury), nonoperative management of blunt splenic injuries can be expected to be successful in more than 80% of cases where it is applied. However, these same criteria would select only about one-quarter of adults with blunt splenic injuries for nonoperative management, and mandate early surgery in the remaining three fourths. There is a limited role for nonoperative management of adults with blunt splenic injuries. The greatest contribution to increasing splenic salvage, however, can be expected to come from improved techniques in operative splenic repair.