RUPTURE OF THE PATHOLOGICAL SPLEEN - IS THERE A ROLE FOR NONOPERATIVETHERAPY

Introduction: While nonoperative management of blunt splenic injury in the stable patient has become the standard of care, splenectomy is st ill advocated as the safest management for rupture of the diseased spl een, The combination of splenectomy and underlying immunosuppression m ay render these patients particularly susceptible to postsplenectomy i nfection, and thus we undertook a prospective trial of nonoperative ma nagement of the ruptured pathologic spleen, Methods: Hemodynamically s table patients with preexisting pathologic splenomegaly and isolated s plenic disruptions diagnosed by computed tomographic (CT) scan (Americ an Association for the Surgery of Trauma (AAST) grades 1-4) requiring 2 or less units blood transfusion were prospectively studied, Patients were monitored in a critical care setting, and resolution of splenic disruption was followed by serial CT examinations, Results: Nonoperati ve management was successful in ail 11 patients (eight, HIV/AIDS; one each, acute leukemia, infectious mononucleosis, sickle cell anemia), T he mean transfusion requirement mas 0.7 units; the mean length of stay was 16 days, Conclusions: The pathologic spleen can heal after parenc hymal disruption, While not appropriate for all patients, a subset of hemodynamically stable patients can be successfully managed nonoperati vely using CT diagnosis, close clinical monitoring, and minimal transf usions.