Case series of non-operative management vs. operative management of splenic injury after blunt trauma

BACKGROUND: The spleen is the most easily injured organ in abdominal trauma. The conservative, operative approach has been challenged by several reports of successful non-operative management aided by the power of modern diagnostic imaging. The aim of our retrospective study was to compare non-operative management with surgery for cases of splenic injury. METHODS: We compared seven patients who were treated with non-operative management (NOM) between 2007 and 2011 to six patients with similar pre-operative characteristics who underwent operative management (OM). RESULTS: The average hospital stay was lower in the NOM group than in the OM group, although the difference was not statistically significant. The NOM group required significantly fewer transfusions, and no patients in the NOM group required admission to the intensive care unit. In contrast 83% of patients in the OM group were admitted to the intensive care unity. The failure rate of NOM was 14.3% in our experience. CONCLUSION: In our experience, NOM is the treatment of choice for grade I, II and III blunt splenic injuries. NOM is slightly less than surgery, but this is an unadjusted comparison and the 95% confidence interval is extremely wide - from 0.04 to 16.99. Splenectomy was the chosen technique in patients who met exclusion criteria for NOM, as well as for patients with grade IV and V injury.