Spleen trauma

The spleen is the intraabdominal organ the most often injured in case of bl unt abdominal trauma. Cases of fulminant infection after splenectomy, both in children and in adults, point to the importance of developing a conserva tive approach to spleen trauma: abstention from surgery, conservative surge ry. Total splenectomy does have its indications resulting either from the g eneral condition of the injured patient, or peroperative observations. Appr oximately 30% of patients operated fur spleen trauma undergo total splenect omy. Over the last 10 years, the proportion of conservative surgery cases h as declined as abstention is increasingly favored, being adopted in 50 to 7 0% of cases with a success rate of at least 90%. Currently two initial crit eria and one evolution criteria guide the decision to abstain from surgery: hemodynamic stability and absence of another intraabdominal lesion requiri ng laparotomy; and limit number of packed red cell units transfused. The decision to abstain from surgery implies very rigorous clinical monitor ing. Imaging protocols vary. Computed tomography signs predictive of recurr ent bleeding and the development of arteriography techniques with embolizat ion mag further raise the rate of success after abstention from surgery.