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[Blunt injuries of the spleen. What is the role of splenectomy?].

In an exhaustive retrospective study of splenic trauma diagnosed over a 7-year period (1986-1992) in our orthopaedic trauma centre we collected 63 cases. Splenectomy was performed in 25 patients, conservative surgery was performed in 6 and non-surgical conservative therapy was possible in 32. The large percentage of non-surgical cases was possible due to the simple clinical course in cases diagnosed late and because of careful surveillance and the precision of scanographic diagnosis. The concept of conservative non-surgical treatment appears to be validated by the lack of mortality and the high success rate (only 3 failures out of 32) in our unselected population which included polytrauma cases and patients of all ages and all types of splenic lesions. Nevertheless, shock resulting from splenic injury. In cases where bleeding is the sign of non-surgical treatment failure and in cases with acquired or induced coagulopathy and a pathological spleen, splenectomy is also indicated. Our results indicate that, when scanographic diagnosis is permanently available and when clinical surveillance is adequate, conservative non-surgical treatment can be proposed in patients with a stable haemodynamic status.